肺癌多学科诊疗模式的绩效评价与资源利用优化:一项真实世界研究

Performance Evaluation and Resource Utilization Optimization of Multidisciplinary Team Model for Lung Cancer: A Real-World Study

  • 摘要: 目的 比较肺癌多学科诊疗(multidisciplinary team, MDT)模式与常规诊疗模式的绩效差异,探索肺癌诊疗资源优化的高质量发展路径。方法 回顾性分析2025年3月—2025年12月上海市胸科医院肺癌患者电子病历数据,根据是否收住肿瘤整合病房分为MDT组与常规诊疗组。采用Mann-Whitney U检验、趋势卡方检验及卡方检验进行统计分析,并按肿瘤分期(Ⅰ~Ⅳ期)和相对权重(relative weight, RW)风险分组进行亚组分析。采用以患者ID为聚类变量的稳健标准误的Gamma回归和负二项回归模型,分析MDT对单次住院费用及观察期内住院次数的影响。为校正观察时间差异,在负二项回归中以观察天数的对数作为偏移量(offset)进行敏感性分析。通过交互作用模型评估MDT在肿瘤分期和RW亚组中的异质性。为增强因果推断的稳健性,进行了倾向性评分匹配(propensity score matching, PSM)和逆概率处理加权(inverse probability of treatment weighting, IPTW)分析作为敏感性验证。结果 共纳入4758例原发性肺癌患者,其中MDT组365例(7.7%)、常规诊疗组4393例(92.3%)。校正混杂因素后,MDT模式使观察期内住院次数显著减少48.8%(IRR=0.512, 95%CI:0.463~0.567,P<0.001),进一步校正观察天数后,MDT仍显著降低住院次数(IRR=0.834, 95%CI:0.698~0.997,P=0.046),效应方向与主分析一致。单次住院总费用未观察到统计学显著差异(IRR=0.942, 95%CI:0.865~1.027,P=0.178)。异质性分析显示,费用效应存在肿瘤分期差异:Ⅰ期患者费用增加(IRR=2.002),Ⅱ期(IRR=0.705)和Ⅳ期(IRR=0.743)费用降低,Ⅲ期无变化。RW亚组费用效应均不显著。整合模式对住院次数的减少效应在各肿瘤分期亚组及RW亚组中均显著(IRR范围:0.450~0.680),且交互作用均不显著(P均>0.05)。敏感性分析证实住院次数效应稳健(PSM:IRR=0.581; IPTW:IRR=0.520), MDT组单次住院总费用显著降低(IRR=0.878, 95%CI:0.778~0.992,P=0.036),而IPTW分析结果与主分析一致,不具有显著统计学意义(IRR=0.943, 95%CI:0.862~1.032,P=0.218)。结论 肺癌MDT模式能显著减少住院次数,但其对单次住院费用的控制效果具有人群选择性,在早期(Ⅰ期)患者中费用增加,在晚期(Ⅱ、Ⅳ期)患者中费用降低。推广MDT模式应实施精准化患者分层管理,优先服务于晚期优势人群,以实现医疗资源的最优配置。

     

    Abstract: Objective To compare the performance differences between the multidisciplinary team (MDT) model and the conventional diagnostic and treatment model for lung cancer, and to explore a high-quality development pathway for optimizing lung cancer diagnostic and treatment resources. Methods A retrospective analysis was conducted on electronic medical record data of lung cancer patients at Shanghai Chest Hospital from March 2025 to December 2025. Patients were divided into an MDT group and a conventional care group based on whether they were admitted to the integrated oncology ward. Statistical analyses were performed using the Mann-Whitney U test, trend chi-square test, and chi-square test. Subgroup analyses were conducted according to tumor stage (Ⅰ-Ⅳ) and relative weight (RW) risk stratification. Gamma regression and negative binomial regression models with robust standard errors clustered by patient ID were used to analyze the effects of MDT on cost per hospitalization and hospitalization frequency during the observation period. To adjust for differences in observation time, the logarithm of observation days was used as an offset in the negative binomial regression. Heterogeneity across tumor stage and RW subgroups was assessed using interaction models. To enhance the robustness of causal inference, propensity score matching (PSM) and inverse probability of treatment weighting (IPTW) analyses were performed as sensitivity validations. Results A total of 4, 758 patients with primary lung cancer were included, comprising 365 (7.7%) in the MDT group and 4, 393 (92.3%) in the conventional care group. After adjusting for confounding factors, the MDT model significantly reduced hospitalization frequency during the observation period by 48.8% (IRR=0.512, 95% CI:0.463-0.567, P<0.001). After further adjusting for observation days, MDT still significantly reduced hospitalization frequency (IRR=0.834, 95% CI:0.698-0.997, P=0.046), with the effect direction consistent with the main analysis. No statistically significant difference was observed in cost per hospitalization (IRR=0.942, 95% CI:0.865-1.027, P=0.178). Heterogeneity analysis revealed that the cost effect varied by tumor stage:cost increased in stage Ⅰ patients (IRR=2.002), decreased in stage Ⅱ (IRR=0.705) and stage Ⅳ (IRR=0.743) patients, and showed no change in stage III patients. No significant cost effects were observed across RW subgroups. The reduction in hospitalization frequency was significant across all tumor stage and RW subgroups (IRR range:0.450-0.680), with no significant interactions (all P>0.05). Sensitivity analyses confirmed the robustness of the hospitalization frequency effect (PSM:IRR=0.581; IPTW:IRR=0.520). The PSM analysis showed a significant reduction in cost per hospitalization in the MDT group (IRR=0.878, 95% CI:0.778-0.992, P=0.036), while the IPTW analysis was consistent with the main analysis and showed no statistical significance (IRR=0.943, 95% CI:0.862-1.032, P=0.218). Conclusions The MDT model for lung cancer significantly reduces hospitalization frequency; however, its effect on cost per hospitalization is population-selective, with increased costs in early-stage (stage Ⅰ) patients and decreased costs in late-stage (stages Ⅱ and Ⅳ) patients. The implementation of the MDT model should adopt precise patient stratification management, prioritizing the optimal patient population to achieve the optimal allocation of medical resources.

     

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