The application of multidisciplinary team diagnosis, treatment, and long-term management in medically unspecified disease
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摘要:
目的 分析某市三甲医院常见未分化疾病住院患者特征、就诊原因、全科及其他专科住院未分化疾病(MUD)患者多学科会诊的诊疗差异及长程管理效果。 方法 选取2022年9月—2023年9月亳州市人民医院常见未分化疾病(以不明原因的水肿、发热、腹痛等)为主要就诊症状之一并申请多学科会诊的患者234例，对其临床资料进行统计分析。选取其中100例患者(无明确的器质性疾病或精神障碍)采用不同管理模式，其中50例MUD患者出院后经三甲医院+社区全科医生团队长程管理(1年)，另外50例MUD患者出院后未经社区长程管理。收集患者的基本情况并进行统计分析。 结果 234例MUD住院患者女性多于男性；年龄为18~99(64.57±16.28)岁；与其他专科相比，全科经未分化疾病-多学科协作(MUD-MDT)诊疗后明确诊断率高、病情好转较多、住院时间少及住院总费用低。不同管理模式下未经社区长程管理MUD患者自我管理得分低于经社区长程管理患者，差异有统计学意义(P＜0.001)。未经社区长程管理MUD患者抑郁、焦虑评估得分均高于经社区长程管理患者(P < 0.05)。 结论 在诊治未分化疾病方面以全科为中心的MUD-MDT诊疗模式相较于专科更有优势、性价比更高；建立未分化疾病“全科-专科-社区”多学科团队诊疗及长程管理，在满足MUD患者的医疗需求、提升MUD患者自我管理能力及减少心理疾病发生率等方面有重大意义。 Abstract:Objective To analyze the clinical characteristics of inpatients with medically unspecified disease (MUD), compare the diagnosis and treatment of MUD-multi-disciplinary team (MUD-MDT) in general practice versus specialties, and evaluate the long-term management effectiveness in tertiary hospital. Methods Clinical data were collected from patients with common MUD and MDT application in Bozhou People' s Hospital from September 2022 to September 2023. A total of 234 cases were included for statistical analysis. Among them, 100 patients without definitive organic or psychiatric diagnoses were selected for further analysis. Of these, 50 MUD patients received long-term community management for one year following discharge, while the other 50 MUD patients did not receive such management after discharge. The basic information of the patients was collected and analyzed statistically. Results Among the 234 MUD inpatients, females outnumbered males. The age range was 18-99 years old, with an average age of (64.57±16.28) years. Compared with specialty departments, MUD-MDT treatment in general practice demonstrated a higher definitive diagnosis rate, greater clinical improvement, shorter hospitalization, and lower total hospitalization cost. Regarding management modes, the self-management scores of MUD patients without long-term community management were lower than those with long-term community management, with a statistically significant difference (P < 0.001). The scores of depression and anxiety in MUD patients without long-term community management were higher than those with long-term community management (P < 0.05). Conclusion In the diagnosis and treatment of undifferentiated diseases, MUD-MDT in general practice is more effective and cost-effective than that in specialty departments. The establishment of "general-specialty-community" multidisciplinary team model for diagnosis, treatment, and long-term management of undifferentiated diseases can improve the self-management ability of MUD patients and reduce the occurrence of mental diseases. -
表 1 234例MUD住院患者一般情况
Table 1. General situation of 234 hospitalized MUD patients
项目 分类 例数(%) 性别 男性 101(43.2) 女性 133(56.8) 年龄(岁) 18~35 13(5.5) 36~55 61(26.1) 56~70 64(27.4) ＞70 96(41.0) 会诊目的 明确诊断指导诊疗 93(39.7) 治疗涉及多学科 51(21.8) 治疗效果不佳 90(38.5) 
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表 2 不同性别及年龄MUD患者主要就诊症状比较[例(%)]
Table 2. Comparison of main symptoms of MUD patients of different genders and ages[cases (%)]
项目 例数 水肿 发热 腹痛 乏力 χ2值 P值 性别 男性 70 20(27.0) 20(48.8) 20(54.0) 10(33.3) 10.066 0.018 女性 112 54(73.0) 21(51.2) 17(55.0) 20(66.7) 年龄(岁) 18~35 11 2(2.7) 6(14.6) 2(5.4) 1(3.3) 12.108 0.187 36~55 52 20(27.0) 15(36.6) 9(24.3) 8(26.7) 56~70 47 21(28.4) 8(19.5) 7(18.9) 11(36.7) ＞70 72 31(41.9) 12(29.3) 19(51.4) 10(33.3)
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表 3 全科医学科与其他专科MUD-MDT患者一般情况比较[M(P25, P75)]
Table 3. Comparison of MUD-MDT patients in general practice and other specialties [M(P25, P75)]
科室 例数 年龄(岁) 住院时间(d) 总费用(元) 全科医学科 117 67(55, 78) 8(6, 12) 4 010(2 999, 5 066) 其他专科 117 68(52, 76) 12(8, 21) 4 577(1 339, 10 636) Z值 -0.634 -4.256 -1.120 P值 0.526 <0.001 0.263
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表 4 全科医学科与其他专科MUD-MDT诊疗后病情转归比较[例(%)]
Table 4. Comparison of disease outcomes after MUD-MDT treatment between general medicine and other specialties[cases (%)]
科室 (自动出院)要求上级医院进一步治疗 放弃治疗自动出院 好转 死亡 全科医学科 14(12.0) 18(15.4) 85(72.6) 0 其他专科 26(22.2) 27(23.1) 61(52.1) 3(2.6) 注：2组病情转归情况比较，χ2=11.905，P=0.005。
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表 5 不同管理模式下MUD患者自我管理及心理健康状态得分比较[M(P25, P75)，分]
Table 5. Comparison of self-management and mental health status scores of MUD patients under different management modes[M(P25, P75), score]
组别 例数 自我管理得分 躯体化症状得分 抑郁评估得分 焦虑评估得分 未经社区长程管理组 50 1.0(1.0, 2.0) 30.0(20.0, 38.5) 5.0(4.0, 13.5) 5.0(3.0, 11.3) 经社区长程管理组 50 4.0(2.8, 4.0) 25.5(20.0, 32.0) 4.0(2.8, 6.5) 4.0(3.0, 6.3) Z值 -7.467 -1.669 -2.561 -1.987 P值 <0.001 0.095 0.010 0.047
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