It’s Not Just a Numbers Thing – Looking for Quality in MDMs (#235)
Multidisciplinary treatment planning meetings (MDM) for cancer are a key component of a mature model of cancer care. However, little is known about how well MDMs are performing. Evaluating the performance of a multidisciplinary team (MDT) goes beyond the numbers of cases presented.
North Eastern Melbourne Integrated Cancer Service serves a population of approximately 1.3 million and has four public health services providing cancer care. There are now 27 MDMs across NEMICS partners, up from 14 in 2006. Approximately 900 patients are currently discussed each month. A 2012 audit showed that 72% of patients have had an MDM discussion.
An evaluation framework was developed for cancer MDMs to assess safety, effectiveness, appropriateness, acceptability, accessibility, and efficiency.
Multiple data sources were required:
· -data from the MDM software system (10,000+ records available)
· - a questionnaire administered to all MDM participants
· -an observational audit of team dynamics
· -an audit of documented MDM recommendations in the medical record
An important part of the model of evaluation is voluntary participation of local team.
This framework was used to evaluate a newly-established region-wide MDM. Findings included:
· Safe – evidence for key information being available ranged from 33% to 100%
· Effective – 100% of records had a documented treatment plan
· Appropriate – good compliance with terms of reference
· Acceptable – 89% of participants agreed that the MDM functioned well
· Accessible – medical record evidence of MDM is 17% since establishment (2% baseline)
· Efficient – chairing, teamwork and culture rated at 15/16 on observational audit
A program of MDM evaluations is planned across the region. These evaluation reports are a key component of the quality improvement cycle and provide benchmarking capability. Results are presented to the teams along with recommendations for improvement. The quality of the MDM is now measured, providing an opportunity for improvement.