Evidence map›Paper›PMID 24915539›Full record

ArticleBMJ quality & safety2014

Determinants of treatment plan implementation in multidisciplinary team meetings for patients with chronic diseases: a mixed-methods study.

Rosalind Raine, Penny Xanthopoulou, Isla Wallace, Caoimhe Nic A' Bháird, Anne Lanceley, Alex Clarke, Gill Livingston, Archie Prentice, Dave Ardron, Miriam Harris and 6 more

Open access · hybridAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in BMJ quality & safety, 2014. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 30 papers, 3 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
30citing papers in PubMed, 3 pooled it
7.7field-weighted citation impact, top 3% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

30 citing papers in PubMed, 3 syntheses or guidelines pooled it, 64 citations in OpenAlex.

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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

16 authors at 7 institutions in 1 country.

Rosalind RaineDepartment of Applied Health Research, University College London, London, UK.
Penny XanthopoulouDepartment of Applied Health Research, University College London, London, UK.
Isla WallaceDepartment of Applied Health Research, University College London, London, UK.ORCID http://orcid.org/0000-0002-8070-3384
Caoimhe Nic A' BháirdDepartment of Applied Health Research, University College London, London, UK.
Anne LanceleyDepartment of Women's Cancer, UCL Elizabeth Garrett Anderson Institute for Women's Health, University College London, London, UK.
Alex ClarkeDepartment of Plastic and Reconstructive Surgery, The Royal Free Hospital, London, UK.
Gill LivingstonDivision of Psychiatry, University College London, London, UK.
Archie PrenticeRoyal College of Pathologists, London, UK.
Dave ArdronNorth Trent Cancer Research Network, Consumer Research Panel, ICOSS, The University of Sheffield, Sheffield, UK.
Miriam HarrisPatient and Public Involvement Representative, London, UK.
Michael KingDivision of Psychiatry, University College London, London, UK.
Susan MichieUCL Centre for Behaviour Change, University College London, London, UK.
Jane M BlazebySchool of Social and Community Medicine, Bristol University, Bristol, UK.
Natalie Austin-ParsonsRoyal College of Psychiatrists, Centre for Quality Improvement, London, UK.
Simon GibbsDepartment of Cardiology, National Heart and Lung Institute, Imperial College London, Hammersmith Hospital, London, UK.
Julie BarberDepartment of Statistical Science, University College London, London, UK.
University College London · GBHammersmith Hospital · GBUniversity of Bristol · GBRoyal College of Pathologists · GBThe Royal Free Hospital · GBUniversity College Hospital · GBUniversity of Sheffield · GB

Funding

Department of Health 09/2001/04
6 · The paper itself

Abstract

objectiveMultidisciplinary team (MDT) meetings are assumed to produce better decisions and are extensively used to manage chronic disease in the National Health Service (NHS). However, evidence for their effectiveness is mixed. Our objective was to investigate determinants of MDT effectiveness by examining factors influencing the implementation of MDT treatment plans. This is a proxy measure of effectiveness, because it lies on the pathway to improvements in health, and reflects team decision making which has taken account of clinical and non-clinical information. Additionally, this measure can be compared across MDTs for different conditions.

methodsWe undertook a prospective mixed-methods study of 12 MDTs in London and North Thames. Data were collected by observation of 370 MDT meetings, interviews with 53 MDT members, and from 2654 patient medical records. We examined the influence of patient-related factors (disease, age, sex, deprivation, whether their preferences and other clinical/health behaviours were mentioned) and MDT features (as measured using the 'Team Climate Inventory' and skill mix) on the implementation of MDT treatment plans.

resultsThe adjusted odds (or likelihood) of implementation was reduced by 25% for each additional professional group represented at the MDT meeting. Implementation was more likely in MDTs with clear goals and processes and a good 'Team Climate' (adjusted OR 1.96; 95% CI 1.15 to 3.31 for a unit increase in Team Climate Inventory (TCI) score). Implementation varied by disease category, with the lowest adjusted odds of implementation in mental health teams. Implementation was also lower for patients living in more deprived areas (adjusted odds of implementation for patients in the most compared with least deprived areas was 0.60, 95% CI 0.39 to 0.91).

conclusionsGreater multidisciplinarity is not necessarily associated with more effective decision making. Explicit goals and procedures are also crucial. Decision implementation should be routinely monitored to ensure the equitable provision of care.

Indexed as

Patient Care PlanningAdultChronic DiseaseDecision MakingEnglandFemaleGoalsHumansInterviews as TopicLeadershipMalePatient Care TeamProspective StudiesChronic Disease ManagementDecision MakingHealth Services ResearchTeamsTeamwork

Identifiers

PMID24915539
PMCPMC4173750
OpenAlexW2166741573

What OpenQuestion holds

Textmetadata
LicenceCC BY-NC
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.