title: Determinants of treatment plan implementation in multidisciplinary team meetings for patients with chronic diseases: a mixed-methods study.
abstract: OBJECTIVE
  Multidisciplinary 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.
  
  
  METHODS
  We 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.
  
  
  RESULTS
  The 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).
  
  
  CONCLUSIONS
  Greater 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.
authors.affiliation: Department of Applied Health Research, University College London, London, UK.
authors.forename: Rosalind
authors.initials: R
authors.lastname: Raine
authors.affiliation: Department of Applied Health Research, University College London, London, UK.
authors.forename: Penny
authors.initials: P
authors.lastname: Xanthopoulou
authors.affiliation: Department of Applied Health Research, University College London, London, UK.
authors.forename: Isla
authors.identifier: http://orcid.org/0000-0002-8070-3384
authors.initials: I
authors.lastname: Wallace
authors.affiliation: Department of Applied Health Research, University College London, London, UK.
authors.forename: Caoimhe
authors.initials: C
authors.lastname: Nic A' Bháird
authors.affiliation: Department of Women's Cancer, UCL Elizabeth Garrett Anderson Institute for Women's Health, University College London, London, UK.
authors.forename: Anne
authors.initials: A
authors.lastname: Lanceley
authors.affiliation: Department of Plastic and Reconstructive Surgery, The Royal Free Hospital, London, UK.
authors.forename: Alex
authors.initials: A
authors.lastname: Clarke
authors.affiliation: Division of Psychiatry, University College London, London, UK.
authors.forename: Gill
authors.initials: G
authors.lastname: Livingston
authors.affiliation: Royal College of Pathologists, London, UK.
authors.forename: Archie
authors.initials: A
authors.lastname: Prentice
authors.affiliation: North Trent Cancer Research Network, Consumer Research Panel, ICOSS, The University of Sheffield, Sheffield, UK.
authors.forename: Dave
authors.initials: D
authors.lastname: Ardron
authors.affiliation: Patient and Public Involvement Representative, London, UK.
authors.forename: Miriam
authors.initials: M
authors.lastname: Harris
authors.affiliation: Division of Psychiatry, University College London, London, UK.
authors.forename: Michael
authors.initials: M
authors.lastname: King
authors.affiliation: UCL Centre for Behaviour Change, University College London, London, UK.
authors.forename: Susan
authors.initials: S
authors.lastname: Michie
authors.affiliation: School of Social and Community Medicine, Bristol University, Bristol, UK.
authors.forename: Jane M
authors.initials: JM
authors.lastname: Blazeby
authors.affiliation: Royal College of Psychiatrists, Centre for Quality Improvement, London, UK.
authors.forename: Natalie
authors.initials: N
authors.lastname: Austin-Parsons
authors.affiliation: Department of Cardiology, National Heart and Lung Institute, Imperial College London, Hammersmith Hospital, London, UK.
authors.forename: Simon
authors.initials: S
authors.lastname: Gibbs
authors.affiliation: Department of Statistical Science, University College London, London, UK.
authors.forename: Julie
authors.initials: J
authors.lastname: Barber
mesh_terms: D000328:Adult; D002908:Chronic Disease / Q000628:therapy*; D003657:Decision Making; D004739:England; D005260:Female; D006040:Goals; D006801:Humans; D007407:Interviews as Topic; D007857:Leadership; D008297:Male; D010347:Patient Care Planning; D010348:Patient Care Team / Q000458:organization & administration*; D011446:Prospective Studies
keywords: Chronic Disease Management; Decision Making; Health Services Research; Teams; Teamwork