Multimorbidity requires that many physicians shift the focus of the care they provide towards the management of multiple chronic conditions such as heart diseases, diabetes, chronic obstructive pulmonary disease and mental illness. The aim of this systematic review is to summarize the scientific evidence on the effects of Multidisciplinary Teams (MDT) on chronic patients' management in hospital settings, evaluating outcomes, costs and workload. Medline, Scopus and Ovid were queried for relevant articles using the Population-Intervention-Context-Outcome (PICO) model. Selected articles were assessed for quality and risk of bias using the National Institutes of Health Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies. Data were analyzed using descriptive statistics, and comparison among comorbid patients with at least one mental illness versus those without was performed using Chi-square test (p < 0,05). Out of 7332 records, 7 studies met the inclusion criteria and 85 indicators were identified: 52% improved significantly, 46% did not show any variation and 2% (nausea and delirium) worsened. In particular, in-hospital mortality was significantly reduced in 65% of the studies describing such indicator. The presence of a mental illness showed a statistically significant increase of length of stay (p < 0,05), hence related to a lower bed-day saving, while no statistically significant effect was observed on 30-day readmissions (p = 0,13). In addition, few studies highlighted that a higher workload leads to greater burn-out rates. MDT meetings represent a fundamental step in a complex path care. They are useful to discuss clinical cases to define their diagnosis and to formulate shared treatment plans in order to deliver personalized treatment options and appropriate follow-up. These findings should stimulate decision makers to invest in the development of MDT and further research should be conducted to evaluate team efficacy.
Di Serafino, F., Pascucci, D., Sassano, M., Di Pilla, A., Carini, E., Specchia, M. L., Ricciardi, W., Damiani, G., (Abstract) Systematic review on multidisciplinarity and management of multimorbid chronic patients in hospital, <<EUROPEAN JOURNAL OF PUBLIC HEALTH>>, 2020; (Volume 30, Issue Supplement_5): v715-v715. [doi:https://doi.org/10.1093/eurpub/ckaa166.501] [https://hdl.handle.net/10807/308421]
Systematic review on multidisciplinarity and management of multimorbid chronic patients in hospital
Pascucci, Domenico;Specchia, Maria Lucia;Ricciardi, Walter;Damiani, Gianfranco
2020
Abstract
Multimorbidity requires that many physicians shift the focus of the care they provide towards the management of multiple chronic conditions such as heart diseases, diabetes, chronic obstructive pulmonary disease and mental illness. The aim of this systematic review is to summarize the scientific evidence on the effects of Multidisciplinary Teams (MDT) on chronic patients' management in hospital settings, evaluating outcomes, costs and workload. Medline, Scopus and Ovid were queried for relevant articles using the Population-Intervention-Context-Outcome (PICO) model. Selected articles were assessed for quality and risk of bias using the National Institutes of Health Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies. Data were analyzed using descriptive statistics, and comparison among comorbid patients with at least one mental illness versus those without was performed using Chi-square test (p < 0,05). Out of 7332 records, 7 studies met the inclusion criteria and 85 indicators were identified: 52% improved significantly, 46% did not show any variation and 2% (nausea and delirium) worsened. In particular, in-hospital mortality was significantly reduced in 65% of the studies describing such indicator. The presence of a mental illness showed a statistically significant increase of length of stay (p < 0,05), hence related to a lower bed-day saving, while no statistically significant effect was observed on 30-day readmissions (p = 0,13). In addition, few studies highlighted that a higher workload leads to greater burn-out rates. MDT meetings represent a fundamental step in a complex path care. They are useful to discuss clinical cases to define their diagnosis and to formulate shared treatment plans in order to deliver personalized treatment options and appropriate follow-up. These findings should stimulate decision makers to invest in the development of MDT and further research should be conducted to evaluate team efficacy.
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