A multidisciplinary approach to complex case management: integrating perspectives across specialties
Keywords:
Multidisciplinary Team, Multi-Morbidity, Patient Outcomes, Tertiary Care, Interdisciplinary Healthcare.Abstract
Background: The modern healthcare requires more and more cases of patients with numerous, clinically relevant, simultaneous conditions to be treated. These complicated cases, which are marked by the existence of a mixture of medical, psychological, pharmacological, and socioeconomic issues-, have been regularly beyond the reach of a single clinical field. The multidisciplinary team (MDT) models provide an orderly, patient-focused approach, whereby a systematically coordinated and formal incorporation of different specialist views is achieved into a coordinated care system.
Aim: The aim of this study is to determine the clinical performance, operational viability, and patient experience with a formally designed MDT model compared to traditional silted care in handling complex and multi-morbid patients in a tertiary hospital.
Methods: A prospective cohort study was designed to be mixed-methods based, and took place at three tertiary referral hospitals in the period of January 2022 and December 2023. Out of 348 adult patients with three or more comorbidities were recruited and assigned to MDT intervention (n= 185) or standard care (n= 163) control group. In the MDT model, weekly interdisciplinary rounds comprising of internists, cardiologists, psychiatrists, clinical pharmacists, dietitians, physiotherapists, and social workers were implemented. The main outcomes were 30-day readmission rate, length of stay, and patient satisfaction. Secondary results included medication errors, compliance to the care plan, and quality-of-life indices.
Findings: MDT group showed statistically significant results in all outcomes. The 30-day readmission rate reduced to 12.4% (p < 0.001). An average length of stay decreased (8.9 to 6.2 days, p < 0.001). The patient satisfaction increased to 4.3 as compared to 3.6 on the five-point scale (p < 0.001). The rates of medication errors reduced by 56 percent, and compliance with care plans rose by 43 percent. Conclusion: Structured MDT-based case management can help to improve clinical outcomes, patient experience, and resource use in multi-morbid populations with complexities in a significant manner to justify its systematic implementation in routine healthcare provision across the globe.
References
K. Barnett, S. W. Mercer, M. Norbury, G. Watt, S. Wyke, and B. Guthrie, 'Epidemiology of multimorbidity and implications for health care, research, and medical education: a cross-sectional study', Lancet, vol. 380, no. 9836, pp. 37-43, July 2012. doi.org/10.1016/S0140-6736(12)60240-2
A. Marengoni et al., 'Aging with multimorbidity: a systematic review of the literature', Ageing Res. Rev., vol. 10, no. 4, pp. 430-439, Sept. 2011. doi.org/10.1016/j.arr.2011.03.003
M. E. Tinetti, T. R. Fried, and C. M. Boyd, 'Designing health care for the most common chronic condition--multimorbidity', JAMA, vol. 307, no. 23, pp. 2493-2494, June 2012. doi.org/10.1001/jama.2012.5265
G. L. Engel, 'The need for a new medical model: a challenge for biomedicine', Science, vol. 196, no. 4286, pp. 129-136, Apr. 1977. doi.org/10.1126/science.847460
S. F. Jencks, M. V. Williams, and E. A. Coleman, 'Rehospitalizations among patients in the Medicare fee-for-service program', N. Engl. J. Med., vol. 360, no. 14, pp. 1418-1428, Apr. 2009. doi.org/10.1056/NEJMsa0803563
A. Fleissig, V. Jenkins, S. Catt, and L. Fallowfield, 'Multidisciplinary teams in cancer care: are they effective in the UK?', Lancet Oncol., vol. 7, no. 11, pp. 935-943, Nov. 2006.doi.org/10.1016/S1470-2045(06)70940-8
H.-J. Kim et al., 'High galectin-1 expression correlates with poor prognosis and is involved in epithelial ovarian cancer proliferation and invasion', Eur. J. Cancer, vol. 48, no. 12, pp. 1914-1921, Aug. 2012. doi.org/10.1016/j.ejca.2012.02.005
B. W. Lamb, K. F. Brown, K. Nagpal, C. Vincent, J. S. A. Green, and N. Sevdalis, 'Quality of care management decisions by multidisciplinary cancer teams: a systematic review', Ann. Surg. Oncol., vol. 18, no. 8, pp. 2116-2125, Aug. 2011. doi.org/10.1245/s10434-011-1675-6
T. S. Clark, 'Regarding: "high-intensity-focused ultrasound in the treatment of primary prostate cancer: the first UK series"', Br. J. Cancer, vol. 101, no. 12, pp. 2055; author reply 2056, Dec. 2009. doi.org/10.1038/sj.bjc.6605453
G. Ellis, M. A. Whitehead, D. Robinson, D. O'Neill, and P. Langhorne, 'Comprehensive geriatric assessment for older adults admitted to hospital: meta-analysis of randomised controlled trials', BMJ, vol. 343, no. oct27 1, p. d6553, Oct. 2011. doi.org/10.1136/bmj.d6553
L. Z. Rubenstein, K. R. Josephson, G. D. Wieland, P. A. English, J. A. Sayre, and R. L. Kane, 'Effectiveness of a geriatric evaluation unit. A randomized clinical trial', N. Engl. J. Med., vol. 311, no. 26, pp. 1664-1670, Dec. 1984. doi.org/10.1056/NEJM198412273112604
B. Starfield, L. Shi, and J. Macinko, 'Contribution of primary care to health systems and health', Milbank Q., vol. 83, no. 3, pp. 457-502, 2005. doi.org/10.1111/j.1468-0009.2005.00409.x
R. Palladino et al., 'Evaluation of the North West London Diabetes Foot Care Transformation project: A mixed-methods evaluation', Int. J. Integr. Care, vol. 22, no. 2, p. 4, Apr. 2022. doi.org/10.5334/ijic.5956
M. Nayak, S. Das, U. Bhanja, and M. R. Senapati, 'Elephant herding optimization technique based neural network for cancer prediction', Inform. Med. Unlocked, vol. 21, no. 100445, p. 100445, 2020.
doi.org/10.1016/j.imu.2020.100445
K. D. Silva, W. K. Lee, A. Forbes, R. T. Demmer, C. Barton, and J. Enticott, 'Use and performance of machine learning models for type 2 diabetes prediction in community settings: A systematic review and meta-analysis', Int. J. Med. Inform., vol. 143, no. 104268, p. 104268, Nov. 2020. doi.org/10.1016/j.ijmedinf.2020.104268
W. L. Miller, B. F. Crabtree, P. A. Nutting, K. C. Stange, and C. R. Jaén, 'Primary care practice development: a relationship-centered approach', Ann. Fam. Med., vol. 8 Suppl 1, no. Suppl_1, pp. S68-79; S92, 2010. doi.org/10.1370/afm.1089
C. M. Boyd, J. Darer, C. Boult, L. P. Fried, L. Boult, and A. W. Wu, 'Clinical practice guidelines and quality of care for older patients with multiple comorbid diseases: implications for pay for performance', JAMA, vol. 294, no. 6, pp. 716-724, Aug. 2005. doi.org/10.1001/jama.294.6.716
A. Coulter and J. Ellins, 'Effectiveness of strategies for informing, educating, and involving patients', BMJ, vol. 335, no. 7609, pp. 24-27, July 2007. doi.org/10.1136/bmj.39246.581169.80
M. T. King, 'A point of minimal important difference (MID): a critique of terminology and methods', Expert Rev. Pharmacoecon. Outcomes Res., vol. 11, no. 2, pp. 171-184, Apr. 2011. doi.org/10.1586/erp.11.9
A. Currie, K. Chong, G. L. Davies, and R. S. Cummins, 'Ultrasonic dissection versus electrocautery in mastectomy for breast cancer - a meta-analysis', Eur. J. Surg. Oncol., vol. 38, no. 10, pp. 897-901, Oct. 2012. doi.org/10.1016/j.ejso.2012.05.006
B. W. Lamb, K. F. Brown, K. Nagpal, C. Vincent, J. S. A. Green, and N. Sevdalis, 'Quality of care management decisions by multidisciplinary cancer teams: a systematic review', Ann. Surg. Oncol., vol. 18, no. 8, pp. 2116-2125, Aug. 2011. doi.org/10.1245/s10434-011-1675-6
L. L. Leape et al., 'Pharmacist participation on physician rounds and adverse drug events in the intensive care unit', JAMA, vol. 282, no. 3, pp. 267-270, July 1999. doi.org/10.1001/jama.282.3.267
S. Greenfield, S. Kaplan, and J. E. Ware Jr, 'Expanding patient involvement in care. Effects on patient outcomes', Ann. Intern. Med., vol. 102, no. 4, pp. 520-528, Apr. 1985. doi.org/10.7326/0003-4819-102-4-520
D. M. Berwick, T. W. Nolan, and J. Whittington, 'The triple aim: care, health, and cost', Health Aff. (Millwood), vol. 27, no. 3, pp. 759-769, May 2008. doi.org/10.1377/hlthaff.27.3.759
V. M. Montori and G. H. Guyatt, 'Progress in evidence-based medicine', JAMA, vol. 300, no. 15, pp. 1814-1816, Oct. 2008. doi.org/10.1001/jama.300.15.1814
Published
How to Cite
Issue
Section
Copyright (c) 2026 Authors
This work is licensed under a Creative Commons Attribution 4.0 International License.
