多学科诊疗已成为现代医学诊疗模式的发展趋势.通过文献综述发现,国外MDT体现了以患者为中心的理念,覆盖了患者咨询、首诊前准备、诊断治疗和后续跟进与支持4个阶段,MDT模式对于提高患者诊断准确率和生存率、慢性病护理和控制医疗费用等有重要作用.我国医疗机构也已纷纷开始探索MDT,但目前面临医疗资源有限、医务人员认识不足、主观能动性不够、配套政策缺乏等问题,建议完善国家支持政策和医院制度建设,构建评价体系,充分把握适应证,并促进MDT与信息化建设和全生命周期管理相结合.

目的:从医生视角分析某三甲医院肿瘤MDT现状,探索优化管理,提高质量与效率,提升对复杂疾病的诊疗与研究水平.方法:采用问卷调查和知情访谈相结合的方式对某三甲医院出席过MDT讨论的医生进行问卷调查.结果:医生对受邀医生配合、明确治疗方案及落实、促进学科交流、临床水平提升评价较高;对病历资料完整性、进入患者指征及后续随访、科研能力提升、绩效水平评价偏低.结论:医院需加强保障、规范管理;严格筛选患者、建立医师库;建设MDT息平台,完善随访和生物样本库建设,发挥外部效应.

OBJECTIVE To study the effectiveness of integrated management portfolio team mode in the management of antimicrobial drug.METHODS Totally 16 641 cases with type Ⅰ incision,who were discharged from Nov 1,2011 to Oct 31,2011,were enrolled in the study.A survey of perioperative use of antibacterial drug was carried out monthly to analyze the utilization rate of antibacterial drug,the rate of reasonable use of antibacterial drugs(including selection of drugs,course of antibiotic treatment and preoperative administration time),and the incidence of surgical site infections;meanwhile,an investigation was conducted on 59951 hospitalized patients for the usage of antibacterial drugs,the intensity of use of antimicrobial agent,proportion of cost of antimicrobial drug,and the submission rate of microbial samples in use of therapeutic antibiotics.RESULTS The rate of perioperative use of antibiotics in type Ⅰ incision operation declined month by month,from 50.35% in Nov 2011 to 24.39% in Oct 2012,while the ratio of reasonable use of antibiotics increased from 80.13% to 92.57%.The incidence rate of the surgical site infections varied between 0.19% and 0.36% in type Ⅰ incision operations.In the hospitalized patients during the same period,the utilization rate of antimicrobial drugs decreased from 57.31% to 48.07%,the intensity of antimicrobial agents use reduced from 64.9DDD to 49.8DDD,and the proportion of antibiotic durgs decreased from 35.44% to 29.97% in the hospital.The submission rate of microbial samples in use of therapeutic antibiotics increased from 60.78% to 64.25%,similarly it increased from 71.88% to 84.65% in therapeutic use of special antibiotics.After inspection,the difference in the submission rate of microbial sample in use of therapeutic antibiotics or the incidence of surgical site infections was not statistically significant,while thedifference in other findings was statistically significant(P0.01). CONCLUSION Integrated management portfolio team mode management can effectively reduce the utilization rate of antibiotics in type I incision operations,raise the rate of reasonable use of antimicrobial drug,effectively reduce the rate of antibacterial drugs cost in the hospital,reduce intensity of antibacterial drugs use,and effectively improve the submission rate of microbial sample in therapeutic use of special antibiotics.

<正>卫生部第84号令发布了《抗菌药物临床应用管理办法》,将于2012年8月1日起施行。根据卫生部的要求:Ⅰ类切口手术预防使用抗菌药物比例不超过30%。围术期预防性抗菌药物滥用不仅浪费医疗资源,增加医疗成本,而且会导致菌群失调、细菌耐药率提高,甚至二重感染。目前,对

阐述了抗菌药物管理的重点及医院管控的难点,重点针对抗菌药物控制的现状、原因进行了分析,并介绍了如何采用信息化手段进行有效控制的方法及实践经验.提出在医疗机构构建全方位的抗菌药物管理控制体系,通过指导临床医生的抗菌药物使用,加强病人用药安全,预防和纠正不合理用药,避免病人过度医疗现象.