多学科协作(MDT)PPT课件

多学科协作（MDT）通向医学未来的必经阶段,Megatrends现代医学诊疗模式大趋势,传统模式：单学科诊疗（看人生的病）必经阶段：多学科协作（看生病的人）,多学科协作Multidisciplinaryteamwork(MDT),MDT是国际顶尖综合医院和专科医院的共识,Cambridge(1766):Atleast2or3roundsofMDTdisscusionforeachcancerpatient.Mass.General(1811):Unitespecialistsacrossthehospitaltoofferpatientscomprehensive,state-of-the-artmedicalcare.MayoClinic(1863):Providingthebestcaretoeverypatientthroughintegratedclinicalpractice,educationandresearch.JohnsHopkins(1879):Providingpatient-centeredmedicinetoprevent,diagnoseandtreathumanillness.MDAnderson(1941):Multidisciplinary,research-drivenpatientcarethroughouteachphaseofthecancercarecycle.,MDT的核心理念,以病人为中心针对特定疾病，依托多学科团队，制定规范化、个体化、连续性的综合治疗方案。,MDT的核心目标,为患者设计最佳诊疗方案，确保最佳疗效。提升学科的诊疗能力和学术水平。医教研健康管理真正融合，推动医学科学进步。,MDT适用于各个学科,例如：我院内分泌科：以多学科协作为特色的理念甲状腺疾病会诊中心（内分泌、外科、眼科、妇产科、核医学）糖尿病足防治中心（内分泌、整形、血管外科、骨科、社区医院）妊娠糖尿病产后随访门诊（内分泌、产科）糖尿病并发症筛查和治疗随访门诊（内分泌、肾内、心内、眼科）肥胖和糖尿病前期管理门诊（内分泌、营养）内分泌高血压专业门诊（内分泌、泌尿外科、影像、神外、介入）,MDT适用于各个学科,MDT适用于各个学科肿瘤治疗是典型的例证,今年80岁，有严重的冠心病、肺气肿，刚刚被确诊前列腺癌，我该怎么办？,假如我是患者,传统医疗模式下，医患双方的共同困惑,关于医院的选择：综合医院能治好我的肿瘤吗？专科医院能保证我的医疗安全吗？关于前列腺癌：就诊科室或医生不同，治疗方案差异巨大多种治疗方法可选：手术、放疗、介入、冷冻、化疗、内分泌治疗、靶向治疗、生物治疗等不同治疗方法各有优缺点对单一学科/医生的治疗效果有所担忧关于高龄及心肺疾病：如何平稳控制，耐受各项治疗措施？,MDT是医患双方的必然选择,通过MDT，与患者充分沟通，为患者找到最适合病情的科学合理的综合诊疗方案，在保证医疗安全的前提下使患者获得最佳疗效。,综合医院案例：MDTatMass.General,CentersandservicesMultidisciplinaryCareCentersCancerCenter就诊途径一CriticalCareCenterDigestiveHealthcareCenterHeartCenterMassGeneralHospitalforChildrenTransplantCenterVascularCenterAlldepartmentsDepartmentofUrology就诊途径二,就诊途径一：TheCancerCenter,TheCancerCenter:Offersacoordinatedteamapproachtailoredtotheindividualneedsofeachpatient。Totally39treatmentprograms.ProstateCancer,ProstateCancer：MultidisciplinaryPatientCareNewpatientsaregenerallyseenwithintwoweeksofreferral.Atyourfirstappointment,youwillmeetthegenitourinarycancerspecialistswhowillbeinvolvedinyourcare.Thesespecialistsmayinclude:Urologistsandsurgicaloncologistsexperiencedinthelatestprostatecancersurgeryapproaches,includinglaparoscopicandroboticsurgeryRadiationOncologistswhospecializeindeliveringtheoptimaltherapeuticdosewhileprotectinghealthytissueMedicalOncologiststoprescribethemosteffectivetreatments,includinghormonetherapy,chemotherapyandimmunotherapy,Inaddition,youmayalsosee:PathologistsspecializinginurologiccancersRadiologistsspecializingingenitourinarycancerimagingOncologynursesandnursepractitionerswhospecializeincancercareOncologypsychiatristsandsocialworkersexperiencedinhelpingwiththecognitivesideeffectsofcancerandtreatment,aswelltheemotionalandspiritualsideofthecancerexperienceAnutritionisttohelpyouwithquestionsaboutdietandnutritionduringtreatmentPalliativecareproviderstoimprovequalityoflifeThisteamwillworkwithyoutodevelopatreatmentplanthatbalancespotentialsideeffectsandbenefitsoftreatment.Theywillcontinuetomonitoryourcareandcommunicateregularlywithyouandyourreferringphysicianaboutyourprogress.,就诊途径二：DepartmentofUrology,Treatments&ServicesCancer:Bladder,Kidney,Penile,ProstateandTesticularCancerProgramErectileDysfunctionServiceFemaleUrologyProgramGeriatricUrologyProgramKidneyStoneProgram,Compassionate&PersonalizedCareOururologistsworkcloselywithallofthecliniciansoneachpatientstreatmentteam,acomprehensiveandhighlycoordinatedapproachmanagedthroughtheworld-renownedMassGeneralCancerCenter.Dependingonyourillnessanddiagnosis,yourtreatmentteamincludesyoururologistalongwithmedicaloncologists,radiationoncologists,radiologistsandpathologists.YoualsohaveaccesstothewidevarietyofresourcesandsupportservicesavailablethroughtheCancerCenter.,UnitespecialistsacrossthehospitaltogiveConsultationsandsupportservicestoensurewedeliverthehighestqualityandsafestcarepossible.,如何为高龄及心肺疾患保驾护航,专科医院案例：MDTatMDAnderson,Brain&SpineCenterBreastCenterColorectalCenterEndocrineCenterGastrointestinalCenterGenitourinaryCenter就诊途径GynecologicOncologyCenter,Head&NeckCenterLeukemiaCenterLymphoma&MyelomaCenterMelanoma&SkinCenterSarcomaCenterThoracicCenter,MultidisciplinaryCancerCareCenters：MostofthenewpatientswhocometoMDAndersoneveryyeararetreatedinoneofourspecializedCancerCareCentersorclinics,whichembodytheteamapproachtocancercarethathasbecomeanMDAndersontrademark,就诊途径：GenitourinaryCancerCenter,MDAndersonsGenitourinary(GU)CancerCenterprovidespersonalizedcareforcancersoftheurinarytractandmalegenitaltract.ThecenterisoneofthemostactiveprogramsinthecountryforGUcancers.Ourgoalistocontrolthecancerandpreservethebestqualityoflifeaftertreatmentfor:ProstatecancerBladdercancerKidneycancerTesticularcancerPenilecancerNonmalignanttumorsoftheurinarytractandmalereproductivesystemVonHippelLindaudisease(VHL),WhyChooseMDAndersonsGenitourinaryCenter?Most-advancedgenitourinarycancertreatmentsincludingprotontherapy,genetherapyandtargetedtherapiesAdvancedsurgicaltechniquesincludinglaser,cryosurgeryandroboticlaparoscopicproceduresHighlyspecializedteamofexpertsDedicationtomaintainingoptimumfunctionandqualityoflifeRangeofclinicaltrialsofnewtreatmentsforgenitourinarycancerWetakeateamapproachtoGUcancer,andourexpertmedicaloncologists,surgicaloncologistsandradiationoncologists-eachhighlyspecializedinaparticulartypeofGUcancercollaboratecloselytocustomizeyourtreatment.,Specialty&TreatmentCentersCancerPreventionCenterCardiopulmonaryCenterIntegrativeMedicineCenterInternalMedicineCenterMohs/DermasurgeryUnitOrthopaedicCenterJulieKyteCenterforReconstructiveSurgeryPainManagementCenterProtonTherapyCenterRadiationTreatmentCenterStemCellTransplantation&CellularTherapyCenterSupportiveCareCenter,如何为高龄及心肺疾患保驾护航,CardiopulmonaryCenterTheCardiopulmonaryCenterbringstogetherexpertswhoperformdiagnosticsandtreatcancerpatientsfordiseasesoftheheart,vasculature,airwayandlungs.MDAndersonsmultidisciplinaryteamincludescardiologists,pulmonologists,nuclearmedicinepersonnel,mid-levelprovidersandtechnicalstaffwhoprovidediagnostics,aswellascomprehensivetreatmentandmanagementofpatientswithcardiacand/orpulmonaryconditions.Ourphysiciansprovidethelatestdiagnosticsandtreatments,including:Three-dimensionalechocardiographywithspeckleandstraintestingCardiaccatheterizationlaboratoryWorld-classinterventionalpulmonarylabPulmonaryfunctiontestingCardiacandpulmonarystresstestingPolysomnographystudies,以该患者为中心的MDT团队构成,前列腺癌核心团队,前列腺癌支持团队,心血管、呼吸、老年内科等协作学科,我院前列腺癌MDT诊治现状,MDT改善前列腺癌等预后的循证医学证据,JeffersonKimmelCancerCenter的研究显示：采用MDT管理前列腺癌患者，10年生存率显著高于NCISEER登记系统内的没有采用MDT管理患者的生存率。原因：个体化综合治疗方案更为及时、合理、有效。,MDT组织结构,MDT普遍模式,针对特定疾病/器官/系统联合接诊/查房/讨论/会议等多学科固定医生参与核心团队支持团队协作诊治学科（更广义MDT）固定时间，固定周期，固定地点形成诊治决议由MDT团队科室执行追踪,MDT基本条件,有一定的病例数（可多病种联合）确定的召集人，固定团队及专家替代制度诊治决议可执行团队人员志同道合，沟通无障碍,MDT最关键标志,让患者体验到！,国内现阶段开展MDT的挑战,宏观：待合理的医疗服务价格体系医院：模糊的医院及学科发展规划学科：传统的学科管理话语权模式医生：个体的诊疗行为主观随意性,MDT的可操作性,可操作性：结合具体情况，寻求突破点，以