Improving access, mixed continuity: effects of multidisciplinary teams on primary health-care in Finland – a quasi-experimental study

The multidisciplinary team (MDT) approach in primary care is a relatively recent innovation, developed over the past 15 years. There is limited data on MDTs’ effects on Quadruple Aim (QA) goals. The object of this study is to evaluate the implementation of a novel MDT from 2021 to 2023 and its impact on access and continuity of care, compared to an established model. Future research will explore its effects on staff satisfaction, costs, and health outcomes. This quasi-experimental study compares five intervention health centers with three control centers. It includes all primary care patients from 2021 to 2023, presenting data on access and continuity before and after the intervention. Nurse-only consultations were replaced with a multidisciplinary nurse-physician model to address issues during initial contact more effectively. Nurses also took on the role of case managers, enhancing relational continuity. Lean daily visual management with continuous improvement, strategic goal setting, and coaching leadership style were implemented. Access was measured using the ‘third available appointment’ (T3) metric, and continuity with the COC-index, both for physicians only. Access improved at all intervention centers, with T3 reduced from 90 to 1.125–4.75 days, while controls remained at 90 days. COC improved at three intervention centers but declined at two, with declines also observed at control centers. The novel MDT enhanced primary care access compared to the traditional model. However, relying solely on T3 may be insufficient for evaluating effectiveness. Mixed results in continuity underscore the need for further investigation.

多学科团队（Multidisciplinary Team, MDT）诊疗模式在基层医疗领域属于相对新兴的创新实践，其发展历程覆盖过去十五年。目前针对MDT对四重照护目标（Quadruple Aim, QA）的影响相关研究数据仍较为匮乏。本研究旨在评估2021至2023年间新型MDT模式的落地实施情况，并对比成熟诊疗模式，分析其对诊疗可及性与照护连续性的影响。后续研究将进一步探讨该模式对医护人员满意度、医疗成本及健康结局的影响。

本项类实验研究共纳入5家干预型医疗中心与3家对照医疗中心开展对比分析。研究样本涵盖2021至2023年间的全部基层医疗患者，提供了干预实施前后的诊疗可及性与照护连续性相关数据。原有的单一护士接诊模式被替换为护士-医师联合的多学科接诊模式，以更高效地解决患者首次接触医疗服务时遇到的问题。同时，护士还承担了病例管理者的职责，以强化服务的关系连续性。研究团队同时推行了带有持续改进机制的精益日常可视化管理、战略目标设定，以及教练式领导风格的管理模式。

诊疗可及性采用「第三次可预约号源（third available appointment, T3）」指标进行评估，照护连续性则采用仅针对医师维度的连续性照护指数（COC-index）进行量化。所有干预型医疗中心的诊疗可及性均得到改善：T3指标从90天降至1.125~4.75天，而对照中心的T3指标仍维持在90天。3家干预型医疗中心的COC指数有所提升，但另外2家出现下降；对照中心同样出现了COC指数下滑的情况。

相较于传统诊疗模式，新型MDT模式可有效提升基层医疗的诊疗可及性。但仅依靠T3指标或许不足以全面评估该模式的实际成效。照护连续性方面的多元结果也凸显了开展后续深入研究的必要性。