This article is based on the work practice of Medical-lnsurance-Medicine Linkage carried out by the Nanping First Hospital Affiliated to Fujian Medical University under the reform of payment based on diagnosis related group (DRG). It outlines the connotation and extension of Medical-lnsurance-Medicine Linkage in the hospital, including concept definition, organizational structure, the relationship between DRG payment and Medical-lnsurance-Medicine Linkage, and summarizes the specific measures and positive results of the Medical-lnsurance-Medicine Linkage work mechanism from four aspects: medical quality management, medical insurance management, medical drugs/consumables management, and performance evaluation. These experiences are of great significance for improving the quality and efficiency of medical care, actively responding to the reform of medical insurance payment methods, enhancing the level of medical services in public hospitals, and achieving a win situation among the medical insurance management departments, hospitals, and patients.
ObjectiveTo investigate the diagnosis and treatment value of multi-disciplinary team (MDT) model in patient with gastrointestinal stromal tumor (GIST) with liver metastasis.MethodThe experiences of MDT model in treating huge (>10 cm) GIST with liver metastasis in the Affiliated Hospital of North Sichuan Medical College on August 2018 were summarized.ResultsThe 46 years old female patient diagnosed with intestinal stromal tumor with liver metastasis at the initial visit. There was no chance of surgery. After the neoadjuvant therapy, the tumor was shrunk. After 2 MDT discussions, the R0 resection of the primary tumor or metastases was successfully performed. And then the patient continued to receive the oral imatinib 600 mg/d. The current overall survival was 31 months till now. No recurrence of the tumor was observed and the follow-up was still continued.ConclusionsTyrosine kinase inhibitors combined metastasectomy may be the most appropriate treatment for patient diagnosed with GIST with liver metastasis, which can improve the survival. In clinical work, MDT model could be used reasonably and carried out during the whole treatment process to provide the best treatment option for patient with GIST with liver metastasis.
Objective To diagnose and treat a patient with obstructive jaundice and hepatic bile duct tumor by multi-disciplinary team (MDT) and to provide individualized treatment. Methods By MDT model, a patient with obstructive jaundice and hepatic bile duct tumor, who was ever misdiagnosed as hilar cholangiocarcinoma, was discussed. The diagnosis, perioperative period management, and operation scheme were carried out by the MDT. Results After discussion of MDT, the patient was diagnosed as " hepatocellular carcinoma with bile duct tumor thrombi”, not " hilar cholangiocarcinoma”. Although hepatocellular carcinoma with bile duct tumor thrombi was end-stage disease, radical treatment was still considered. A plan of treatment was carried out by the MDT. Firstly, the percutaneous transhepatic cholangial drainage was operated for the predicted reserved half liver to relieve biliary obstruction. Secondly, hemihepatectomy combined with bile duct resection was carried out by the surgery team. The patient had nice postoperative recovery and there was no tumor recurrence after 6-month follow-up after surgery up to now. Conclusions MDT model do not only reduce misdiagnose, but also can provide the best therapeutic regimen and individualized treatment for patient presented with obstructive jaundice and hepatic bile duct tumor.
ObjectiveThe present study was to investigate the value of multi-disciplinary team (MDT) model in patient with primary giant liver cancer.MethodsThe MDT model was carried out for a BCLC B stage patient who admitted in the Second Affiliated Hospital of Chongqing Medical University in July 2018. The associated references were reviewed and the treatment methods were discussed about primary giant liver cancer.ResultsAn elder man who was diagnosed as primary hepatocellular carcinoma (minor cancer) in right lobe of the liver in three years ago and took Chinese medicine orally. When the patient subsequent visited this time, the liver cancer increased about 10 cm. After discussed by MDT, the treatment method was draw up to transarterial chemoembolization (TACE) plus surgery. After received twice TACE therapies in the later 14 weeks, the tumor in right lobe had significantly shrinked and left lobe enlarged. The patient underwent laparoscopic right liver hepatectomy after the second MDT discussion in 5 months later. The patient underwent operation successfully. The operation lasted for 270 minutes, and the intraoperative blood loss was about 500 mL. The suspended red blood cells (400 mL) was infused. The patient underwent transient liver failure and recovered through hepatoprotective and symptomatic supportive treatment, and discharged on 12 days after operation. A retrospective examination of abdominal CT at 4 months postoperatively revealed a significant hyperplasia of the left lobe of the liver, and there was no sign of recurrent tumor. The patient was continue to followed up.ConclusionsThepatient with primary giant hepatocellular carcinoma who cannot underwent surgery at the first time can received TACE, and a few patients could be underwent radical operation later. MDT should be applied flexibly in the treatment of patients with huge hepatocellular carcinoma from beginning to end, so the best treatment plan should be carried out for patients.
ObjectiveTo investigate the value of multi-disciplinary team (MDT) for the diagnosis and treatment of postoperative recurrence of hepatocellular carcinoma (HCC). MethodThe clinicopathologic data of a patient with giant HCC (66 mm×60 mm×102 mm) who was multiple intrahepatic metastases with portal vein tumor thrombus after radical resection, admitted to the Department of Hepatobiliary Surgery of Sichuan Provincial People’s Hospital, were gathered. ResultsThe patient was a middle-aged male. The multiple recurrent intrahepatic metastases combined with portal vein right branch thrombosis was found at 1 month after radical hepatectomy. After MDT discussion and evaluation, the hepatic arterial infusion chemotherapy combined with immunotherapy and targeted therapy (chemical drugs regimen was FOLFOX, immunotherapy drug was sindilizumab, targeted therapy drug was lenvatinib) was administered. After 3 times conversion therapy, and most of the intrahepatic lesions liquefied and necrotic and shrunk markedly or disappeared. After further discussion and evaluation by MDT, radical surgical resection was performed. The postoperative pathological examination results showed granulomatous inflammation with necrosis, and no exact liver cancer cells were detected. At 6 months after surgery, no tumor recurrence was observed.ConclusionsFor early recurrence combined with portal vein thrombosis after radical resection for HCC, hepatic arterial infusion chemotherapy combined with immunotherapy and targeted therapy may still be effective and even has an opporunity of surgical therapy. MDT discussion can provide the best treatment plan for patient with recurrent liver cancer, leading to a better clinical outcome for them.
ObjectiveTo investigate treatment of severe acute pancreatitis (SAP) concurrent peripancreatic walled-off necrosis.MethodsThe clinical data and treatment of a patient with SAP from the Second Affiliated Hospital of Chongqing Medical University were retrospectively analyzed. The results of discussion of multidisciplinary team (MDT) were summarized.ResultsThe patient was admitted for the SAP with high fever, abdominal pain, and dyspnea for 2 weeks. The enhanced CT scan of the upper abdomen presented severe acute necrotizing pancreatitis with massive peripancreatic walled-off necrosis and pleural effusion. After the full discussion of SAP MDT, the percutaneous sinus tract necrosectomy (PSTN) was performed to relieved the symptom. After the two-stage PSTN treatment, the peripancreatic necrotic tissue was obviously reduced, the drainage was unobstructed, the clinical symptoms and biochemical indicators were obviously improved, and the patient was discharged on day 6 after the surgery.ConclusionsSAP is a critical situation with rapid progression and high mortality, and timing and approach of intervention for complications are very difficult to handle. PSTN could treat SAP with early appearance of infection or walled-off necrosis, which has advantages of less trauma, higher efficiency, and faster recovery as compared with traditional method and is of valuable in clinical practice.
In response to the current situation of regional medical and health hierarchical diagnosis and treatment services and the existing problems in the continuity of medical services, this article applies supply chain management methods, system collaboration theory, and service ecosystem concepts to treat medical consortia as an organic whole. Based on the quality and efficiency of disease management in the whole life cycle of patients with difficult, complex and severe diseases, a multi-level and multi-disciplinary medical service supply chain model of difficult, complex and severe disease medical consortium is constructed with four core elements: patient flow, service flow, technology flow and information flow. This article provides a certain reference for the implementation of regional hierarchical diagnosis and treatment and the formulation of relevant policies in China from the perspective of theoretical research.
Objective To analyze the implementation of multi-disciplinary team (MDT) clinic for thyroid eye disease (TED) and explore the significance of TED MDT clinic. Methods A retrospective analysis was conducted on the medical records of patients who visited TED MDT clinic at West China Hospital of Sichuan University between December 1, 2022 and November 30, 2024. Patient condition indicators were collected and MDT outpatient operation indicators were statistically analyzed. Results During the study period, a total of 696 patients were admitted to the TED MDT clinic, with an average age of (51.14±12.00) years. All patients were diagnosed with TED and showed symptoms of extraocular muscle involvement and restricted eye movement. According to the NOSPECS clinical grading system, all patients were classified as grade 4 or above. Among them, 693 patients’ orbital enhanced MRI showed that the extraocular muscles were in an inflammatory active phase, and 690 patients received periarbital injection of triamcinolone acetonide, precise orbital radiation therapy, and thyroid function regulation. During the research period, TED MDT clinic received a total of 90 visits, with an average of 7.73 patients per visit. The patient satisfaction rate was 99.67%, and there were no cases of experts being late, absent, or doctors with insufficient qualifications to participate in discussions. ConclusionThe TED MDT clinic has been well developed, and the experts within the team attach great importance to it, making it valuable for continued large-scale promotion.
Objective To explore the clinical practice effects of multi-disciplinary team (MDT) model led by enterostomal therapist in the diagnosis and treatment of chronic wounds. Methods Three types of subspecialty patients diagnosed and treated by the MDT team for chronic wounds in the Wound Care Center of West China Hospital of Sichuan University between January 2020 and December 2022, including MDT for diabetes feet, MDT for immune ulcer and MDT for other refractory wounds, were retrospectively included. The clinical data, healing rate, healing time, and satisfaction rate of patients were analyzed. Results A total of 176 patients were included, including 103 cases of diabetes foot, 31 cases of immune ulcer, and 42 cases of other refractory wounds. The healing rate was 71.84% in patients with MDT of diabetes foot, 74.19% in patients with MDT of immune ulcer and 78.57% in patients with MDT of other refractory wound. The average healing time was 18.10 weeks for patients with diabetes foot, 19.69 weeks for patients with immune ulcer, and 20.53 weeks for patients with other refractory wounds. The satisfaction rates of patients in the three groups were relatively high (>95%). Conclusion The MDT model led by enterostomal therapist can provide comprehensive treatment plans for difficult and complex chronic wound patients, improve the treatment outcomes of chronic wounds, and is worthy of further promotion and application in the clinical diagnosis and treatment of chronic wounds.
ObjectiveTo investigate the diagnosis and treatment value of multi-disciplinary team (MDT) model in patient with gastric perforation combined with hyperthyroidism crisis.MethodWe summarized the experiences of MDT model in treating one case of gastric perforation with hyperthyroidism crisis in the Fuling Central Hospital of Chongqing City on February 2019.ResultsThis patient had a history of hyperthyroidism and didn’t receive systemic treatment, diagnosing as acute diffuse peritonitis and perforation of hollow organs. After MDT discussions and a series of treatments, including anti-infection, control of heart rate and hyperthyroidism, this patient underwent surgical treatment of gastric peptic ulcer perforation, during and after the surgery, this patient suffered from hyperthyroid crisis. The surgery was successful, with the operation time was about 110 min, and the blood loss was about 50 mL. There was no side injury occurred without blood transfusion, and the patient was cured and discharged on 20 days after operation. The patient was followed up for about 1 year, and the general condition and life returned to normal.ConclusionMDT discussion is a very helpful way in the treatment of gastric perforation combined with hyperthyroidism crisis and can give a better outcome.