基于Donabedian模型的肺癌患者多学科诊疗模式分析

Analysis of the Multidisciplinary Team (MDT) Model for Lung Cancer Patients Based on the Donabedian Framework

摘要: 目的：基于Donabedian“结构–过程–结果”模型构建肺癌多学科诊疗(MDT)质量评价框架，评估某三甲医院肺癌MDT运行质量。方法：收集2025年全年肺癌MDT运行数据并进行描述性统计分析，同时对8名核心科室骨干开展半结构式访谈，从结构、过程与结果三个维度进行综合评价。结果：2025年共开展肺癌MDT讨论481例，月均40.08例(SD = 12.27)。结构维度显示团队组织架构较为完善，制度与信息系统基本健全，但资源协调与节点提醒仍有优化空间。过程维度显示病例纳入主要依赖主动申请，不同科室对纳入标准理解存在差异，会前资料准备与执行反馈衔接不足。结果维度显示MDT有助于提升治疗决策规范化程度与多学科一致性，在疑难复杂病例管理中优势明显。结论：基于Donabedian模型的评价框架能够系统揭示肺癌MDT运行质量特征。进一步完善标准化纳入机制与闭环管理流程，有助于提升MDT运行效率与决策质量。

Abstract: Objective: To construct a quality evaluation framework for multidisciplinary team (MDT) management of lung cancer based on Donabedian’s “Structure-Process-Outcome” model, and to assess the operational quality of a lung cancer MDT in a tertiary hospital. Methods: Operational data from lung cancer MDT meetings conducted throughout 2025 were collected and analyzed using descriptive statistics. In addition, semi-structured interviews were conducted with eight key members from core departments. A comprehensive evaluation was performed from the perspectives of structure, process, and outcome. Results: A total of 481 lung cancer cases were discussed in MDT meetings in 2025, with a monthly average of 40.08 cases (SD = 12.27). In the structure dimension, the MDT demonstrated a relatively well-established organizational framework, with sound institutional policies and information systems; however, resource coordination and reminder mechanisms at key workflow nodes require further optimization. In the process dimension, case inclusion primarily relied on voluntary application, and variations existed among departments in their understanding of inclusion criteria. Insufficient linkage was observed between pre-meeting case preparation and post-decision implementation feedback. In the outcome dimension, MDT participation contributed to improved standardization of treatment decisions and enhanced multidisciplinary consensus, with particular advantages in the management of complex and challenging cases. Conclusion: The evaluation framework based on Donabedian’s model systematically reveals the operational characteristics of lung cancer MDT quality. Further refinement of standardized case inclusion mechanisms and closed-loop management processes may enhance MDT efficiency and decision-making quality.