多學(xué)科協(xié)作mdt-ppt課件

1、Women & ChildrenInternal Med & SurgeryOutpatient & ERState councilCPC headquarter1915Mega trends現(xiàn)代醫(yī)學(xué)診療模式大趨勢(shì)現(xiàn)代醫(yī)學(xué)診療模式大趨勢(shì)傳統(tǒng)模式：?jiǎn)螌W(xué)科診療看人生的?。﹤鹘y(tǒng)模式：?jiǎn)螌W(xué)科診療看人生的?。┍亟?jīng)階段：多學(xué)科協(xié)作必經(jīng)階段：多學(xué)科協(xié)作 （看生病的人）（看生病的人）多學(xué)科協(xié)作多學(xué)科協(xié)作Multidisciplinary teamwork (MDT)Multidisciplinary teamwork (MDT)MDT是國(guó)際頂尖綜合醫(yī)院和?？漆t(yī)院的共識(shí)是國(guó)際頂尖綜合醫(yī)院和專科醫(yī)院的共識(shí)Camb

2、ridge (1766) : At least 2 or 3 rounds of MDT disscusion for each cancer patient.Mass. General (1811) : Unite specialists across the hospital to offer patients comprehensive, state-of-the-art medical care. Mayo Clinic (1863) : Providing the best care to every patient through integrated clinical pract

3、ice, education and research.Johns Hopkins (1879) : Providing patient-centered medicine to prevent, diagnose and treat human illness . MD Anderson (1941) : Multidisciplinary, research-driven patient care throughout each phase of the cancer care cycle. MDT的核心理念的核心理念 以病人為中心以病人為中心 針對(duì)特定疾病，依托多學(xué)科團(tuán)隊(duì)，制定規(guī)范化、個(gè)

4、體針對(duì)特定疾病，依托多學(xué)科團(tuán)隊(duì)，制定規(guī)范化、個(gè)體化、連續(xù)性的綜合治療方案?；⑦B續(xù)性的綜合治療方案。MDT的核心目標(biāo)的核心目標(biāo) 為患者設(shè)計(jì)最佳診療方案，確保最佳療效。為患者設(shè)計(jì)最佳診療方案，確保最佳療效。 提升學(xué)科的診療能力和學(xué)術(shù)水平。提升學(xué)科的診療能力和學(xué)術(shù)水平。 醫(yī)教研健康管理真正融合，推動(dòng)醫(yī)學(xué)科學(xué)進(jìn)步。醫(yī)教研健康管理真正融合，推動(dòng)醫(yī)學(xué)科學(xué)進(jìn)步。MDT 適用于各個(gè)學(xué)科適用于各個(gè)學(xué)科 例如：我院內(nèi)分泌科：以多學(xué)科協(xié)作為特色的理念例如：我院內(nèi)分泌科：以多學(xué)科協(xié)作為特色的理念 甲狀腺疾病會(huì)診中心內(nèi)分泌、外科、眼科、婦產(chǎn)科甲狀腺疾病會(huì)診中心內(nèi)分泌、外科、眼科、婦產(chǎn)科、核醫(yī)學(xué)）、核醫(yī)學(xué)） 糖尿病足防

5、治中心內(nèi)分泌、整形、血管外科、骨科糖尿病足防治中心內(nèi)分泌、整形、血管外科、骨科、社區(qū)醫(yī)院）、社區(qū)醫(yī)院） 妊娠糖尿病產(chǎn)后隨訪門診內(nèi)分泌、產(chǎn)科）妊娠糖尿病產(chǎn)后隨訪門診內(nèi)分泌、產(chǎn)科） 糖尿病并發(fā)癥篩查和治療隨訪門診內(nèi)分泌、腎內(nèi)、糖尿病并發(fā)癥篩查和治療隨訪門診內(nèi)分泌、腎內(nèi)、心內(nèi)、眼科）心內(nèi)、眼科） 肥胖和糖尿病前期管理門診內(nèi)分泌、營(yíng)養(yǎng)）肥胖和糖尿病前期管理門診內(nèi)分泌、營(yíng)養(yǎng)） 內(nèi)分泌高血壓專業(yè)門診內(nèi)分泌、泌尿外科、影像、內(nèi)分泌高血壓專業(yè)門診內(nèi)分泌、泌尿外科、影像、神外、介入）神外、介入）MDT 適用于各個(gè)學(xué)科適用于各個(gè)學(xué)科MDT 適用于各個(gè)學(xué)科適用于各個(gè)學(xué)科腫瘤治療是典型的例證腫瘤治療是典型的例證今年今

6、年80歲，有嚴(yán)重的冠心病、肺氣腫，歲，有嚴(yán)重的冠心病、肺氣腫，剛剛被確診前列腺癌，我該怎么辦？剛剛被確診前列腺癌，我該怎么辦？假如我是患者假如我是患者傳統(tǒng)醫(yī)療模式下，醫(yī)患雙方的共同困惑傳統(tǒng)醫(yī)療模式下，醫(yī)患雙方的共同困惑 關(guān)于醫(yī)院的選擇：關(guān)于醫(yī)院的選擇： 綜合醫(yī)院能治好我的腫瘤嗎？綜合醫(yī)院能治好我的腫瘤嗎？ ?？漆t(yī)院能保證我的醫(yī)療安全嗎？?？漆t(yī)院能保證我的醫(yī)療安全嗎？ 關(guān)于前列腺癌：關(guān)于前列腺癌： 就診科室或醫(yī)生不同，治療方案差異巨大就診科室或醫(yī)生不同，治療方案差異巨大 多種治療方法可選：手術(shù)、放療、介入、冷凍、化療、內(nèi)多種治療方法可選：手術(shù)、放療、介入、冷凍、化療、內(nèi)分泌治療、靶向治療、生物治

7、療等分泌治療、靶向治療、生物治療等 不同治療方法各有優(yōu)缺點(diǎn)不同治療方法各有優(yōu)缺點(diǎn) 對(duì)單一學(xué)科對(duì)單一學(xué)科 / / 醫(yī)生的治療效果有所擔(dān)憂醫(yī)生的治療效果有所擔(dān)憂 關(guān)于高齡及心肺疾病：關(guān)于高齡及心肺疾?。?如何平穩(wěn)控制，耐受各項(xiàng)治療措施？如何平穩(wěn)控制，耐受各項(xiàng)治療措施？MDT 是醫(yī)患雙方的必然選擇是醫(yī)患雙方的必然選擇 通過通過MDT，與患者充分溝通，為患者找到最適合病情的，與患者充分溝通，為患者找到最適合病情的科學(xué)合理的綜合診療方案，在保證醫(yī)療安全的前提下使患者科學(xué)合理的綜合診療方案，在保證醫(yī)療安全的前提下使患者獲得最佳療效。獲得最佳療效。綜合醫(yī)院案例：綜合醫(yī)院案例：MDT at Mass. Gen

8、eralMDT at Mass. General Centers and services Multidisciplinary Care Centers Cancer Center 就診途徑一就診途徑一 Critical Care Center Digestive Healthcare Center Heart Center MassGeneral Hospital for Children Transplant Center Vascular Center All departments Department of Urology 就診途徑二就診途徑二就診途徑一： The Cancer Ce

9、nter The Cancer Center: Offers a coordinated team approach tailored to the individual needs of each patient。 Totally 39 treatment programs. Prostate CancerProstate Cancer ：Multidisciplinary Patient CareNew patients are generally seen within two weeks of referral. At your first appointment, you will

10、meet the genitourinary cancer specialists who will be involved in your care. These specialists may include:Urologists and surgical oncologists experienced in the latest prostate cancer surgery approaches, including laparoscopic and robotic surgery Radiation Oncologists who specialize in delivering t

11、he optimal therapeutic dose while protecting healthy tissue Medical Oncologists to prescribe the most effective treatments, including hormone therapy, chemotherapy and immunotherapy In addition, you may also see: Pathologists specializing in urologic cancers Radiologists specializing in genitourinar

12、y cancer imaging Oncology nurses and nurse practitioners who specialize in cancer care Oncology psychiatrists and social workers experienced in helping with the cognitive side effects of cancer and treatment, as well the emotional and spiritual side of the cancer experience A nutritionist to help yo

13、u with questions about diet and nutrition during treatment Palliative care providers to improve quality of life This team will work with you to develop a treatment plan that balances potential side effects and benefits of treatment. They will continue to monitor your care and communicate regularly w

14、ith you and your referring physician about your progress.就診途徑二： Department of Urology Treatments & Services Cancer: Bladder, Kidney, Penile, Prostate and Testicular Cancer Program Erectile Dysfunction Service Female Urology Program Geriatric Urology Program Kidney Stone Program Compassionate & Perso

15、nalized Care Our urologists work closely with all of the clinicians on each patients treatment team, a comprehensive and highly coordinated approach managed through the world-renowned Mass General Cancer Center. Depending on your illness and diagnosis, your treatment team includes your urologist alo

16、ng with medical oncologists, radiation oncologists, radiologists and pathologists. You also have access to the wide variety of resources and support services available through the Cancer Center. Unite specialists across the hospital to give Consultations and support services to ensure we deliver the

17、 highest quality and safest care possible. 如何為高齡及心肺疾患保駕護(hù)航如何為高齡及心肺疾患保駕護(hù)航專科醫(yī)院案例：?？漆t(yī)院案例：MDT at MD AndersonMDT at MD Anderson Brain & Spine Center Breast Center Colorectal Center Endocrine Center Gastrointestinal Center Genitourinary Center 就診途徑就診途徑 Gynecologic Oncology Center Head & Neck Center Leukemi

18、a Center Lymphoma & Myeloma Center Melanoma & Skin Center Sarcoma Center Thoracic CenterMultidisciplinary Cancer Care Centers：Most of the new patients who come to MD Anderson every year are treated in one of our specialized Cancer Care Centers or clinics, which embody the team approach to cancer car

19、e that has become an MD Anderson trademark就診途徑：就診途徑： Genitourinary Cancer Center Genitourinary Cancer Center MD Andersons Genitourinary (GU) Cancer Center provides personalized care for cancers of the urinary tract and male genital tract. The center is one of the most active programs in the country

20、for GU cancers. Our goal is to control the cancer and preserve the best quality of life after treatment for: Prostate cancer Bladder cancer Kidney cancer Testicular cancer Penile cancer Nonmalignant tumors of the urinary tract and male reproductive system Von Hippel Lindau disease (VHL) Why Choose M

21、D Andersons Genitourinary Center? Most-advanced genitourinary cancer treatments including proton therapy, gene therapy and targeted therapies Advanced surgical techniques including laser, cryosurgery and robotic laparoscopic procedures Highly specialized team of experts Dedication to maintaining opt

22、imum function and quality of life Range of clinical trials of new treatments for genitourinary cancer We take a team approach to GU cancer, and our expert medical oncologists, surgical oncologists and radiation oncologists - each highly specialized in a particular type of GU cancer collaborate close

23、ly to customize your treatment. Specialty & Treatment Centers Cancer Prevention Center Cardiopulmonary Center Integrative Medicine Center Internal Medicine Center Mohs/Dermasurgery Unit Orthopaedic Center Julie Kyte Center for Reconstructive Surgery Pain Management Center Proton Therapy Center Radia

24、tion Treatment Center Stem Cell Transplantation & Cellular Therapy Center Supportive Care Center如何為高齡及心肺疾患保駕護(hù)航如何為高齡及心肺疾患保駕護(hù)航 Cardiopulmonary Center The Cardiopulmonary Center brings together experts who perform diagnostics and treat cancer patients for diseases of the heart, vasculature, airway and

25、lungs. MD Andersons multidisciplinary team includes cardiologists, pulmonologists, nuclear medicine personnel, mid-level providers and technical staff who provide diagnostics, as well as comprehensive treatment and management of patients with cardiac and/or pulmonary conditions. Our physicians provi

26、de the latest diagnostics and treatments, including: Three-dimensional echocardiography with speckle and strain testing Cardiac catheterization laboratory World-class interventional pulmonary lab Pulmonary function testing Cardiac and pulmonary stress testing Polysomnography studies以該患者為中心的以該患者為中心的M

27、DTMDT團(tuán)隊(duì)構(gòu)成團(tuán)隊(duì)構(gòu)成 前列腺癌核心團(tuán)隊(duì)前列腺癌核心團(tuán)隊(duì)前列腺癌支持團(tuán)隊(duì)前列腺癌支持團(tuán)隊(duì)心血管、呼吸、老年內(nèi)科等協(xié)作學(xué)科心血管、呼吸、老年內(nèi)科等協(xié)作學(xué)科我院前列腺癌我院前列腺癌MDTMDT診治現(xiàn)狀診治現(xiàn)狀MDT改善前列腺癌等預(yù)后的循證醫(yī)學(xué)證據(jù)改善前列腺癌等預(yù)后的循證醫(yī)學(xué)證據(jù)Jefferson Kimmel Cancer Center的研究顯示：采用的研究顯示：采用MDT管理前管理前列腺癌患者，列腺癌患者，10年生存率顯著高于年生存率顯著高于NCI SEER登記系統(tǒng)內(nèi)的沒登記系統(tǒng)內(nèi)的沒有采用有采用MDT管理患者的生存率。管理患者的生存率。原因：個(gè)體化綜合治療方案更為及時(shí)、合理、有效。原因：個(gè)

28、體化綜合治療方案更為及時(shí)、合理、有效。MDT 組織結(jié)構(gòu)組織結(jié)構(gòu)MDT 普遍模式普遍模式針對(duì)特定疾病針對(duì)特定疾病 / / 器官器官 / / 系統(tǒng)系統(tǒng)聯(lián)合接診聯(lián)合接診 / / 查房查房 / / 討論討論 / / 會(huì)議等會(huì)議等多學(xué)科固定醫(yī)生參與多學(xué)科固定醫(yī)生參與核心團(tuán)隊(duì)核心團(tuán)隊(duì)支持團(tuán)隊(duì)支持團(tuán)隊(duì)協(xié)作診治學(xué)科協(xié)作診治學(xué)科 （更廣義（更廣義MDTMDT）固定時(shí)間，固定周期，固定地點(diǎn)固定時(shí)間，固定周期，固定地點(diǎn)形成診治決議形成診治決議由由MDTMDT團(tuán)隊(duì)科室執(zhí)行追蹤團(tuán)隊(duì)科室執(zhí)行追蹤MDT 基本條件基本條件 有一定的病例數(shù)可多病種聯(lián)合）有一定的病例數(shù)可多病種聯(lián)合） 確定的召集人，固定團(tuán)隊(duì)及專家替代制度確定的召

29、集人，固定團(tuán)隊(duì)及專家替代制度 診治決議可執(zhí)行診治決議可執(zhí)行 團(tuán)隊(duì)人員志同道合，溝通無障礙團(tuán)隊(duì)人員志同道合，溝通無障礙MDT最關(guān)鍵標(biāo)志最關(guān)鍵標(biāo)志 讓患者體驗(yàn)到！讓患者體驗(yàn)到！國(guó)內(nèi)現(xiàn)階段開展國(guó)內(nèi)現(xiàn)階段開展MDT 的挑戰(zhàn)的挑戰(zhàn)宏觀：待合理的醫(yī)療服務(wù)價(jià)格體系宏觀：待合理的醫(yī)療服務(wù)價(jià)格體系醫(yī)院：模糊的醫(yī)院及學(xué)科發(fā)展規(guī)劃醫(yī)院：模糊的醫(yī)院及學(xué)科發(fā)展規(guī)劃學(xué)科：傳統(tǒng)的學(xué)科管理話語權(quán)模式學(xué)科：傳統(tǒng)的學(xué)科管理話語權(quán)模式醫(yī)生：個(gè)體的診療行為主觀隨意性醫(yī)生：個(gè)體的診療行為主觀隨意性MDT 的可操作性的可操作性可操作性：結(jié)合具體情況，尋求突破點(diǎn)，以點(diǎn)帶面可操作性：結(jié)合具體情況，尋求突破點(diǎn)，以點(diǎn)帶面Blind dates / Matchmaking有人推動(dòng)，走到一起是開始，保持下去是進(jìn)步，形成團(tuán)隊(duì)是有人推動(dòng)，走到一起是開始，保持下去是進(jìn)步，形成團(tuán)隊(duì)是成功。成功。從大家感興趣的事做起，從最容易的事做起，從對(duì)方最需要從大家感興趣的事做起，從最容易的事做起，從對(duì)方最需要的事做起的事做起協(xié)作始于自覺，完善需要制度協(xié)作始于自覺，