What is an integrated team evaluation?

What is Integrated Team Evaluation?

Integrated team evaluation is a multidisciplinary assessment approach where healthcare professionals from different specialties collaboratively evaluate a patient to develop a comprehensive diagnostic and treatment plan, with the specific composition and leadership of the team determined by the patient's clinical needs rather than traditional hierarchy. 1

Core Components of Integrated Team Evaluation

Team Composition

• The team must include representatives from all relevant disciplines needed to address the patient's specific condition, which typically includes physicians from multiple specialties, advanced practice nurses, pharmacists, social workers, and other healthcare professionals as clinically indicated 1
• For complex medical conditions, the American College of Chest Physicians recommends teams include pulmonary medicine, thoracic surgery, medical oncology, radiation oncology, palliative care, radiology, and pathology representatives 1
• For chronic disease management, teams should incorporate primary care clinicians, specialists, pharmacists, mental health professionals, and case managers 2

Dynamic Leadership Structure

• Leadership responsibility shifts based on patient needs rather than professional hierarchy, with different clinicians assuming principal responsibility for specific elements of care as appropriate to their training and the clinical situation 1, 3
• The team member with the most relevant expertise for the patient's current primary problem leads the evaluation and decision-making for that specific aspect of care 1

Operational Framework

Meeting Structure and Logistics

• Teams should convene regularly with each case discussed in 5-10 minutes to maintain efficiency and physician engagement 1
• For centers without on-site specialty departments, integrated team meetings can be organized through teleconference with integrated screen sharing capabilities 1
• Research nurses or coordinators should gather necessary data beforehand and present score assessments on a plenary screen to avoid calculation errors 1

Decision-Making Process

The evaluation follows three key steps: 1

1. Knowledge transfer - bidirectional information exchange between physicians and patient
2. Discussion - collaborative analysis among team members
3. Agreement - reaching consensus on the optimal strategy while prioritizing patient preferences

Patient Integration

• Patients and their families should be integrated into the team evaluation process to increase satisfaction and ensure shared decision-making 1
• At least one clinical/non-invasive specialist, one interventional specialist, and one surgeon (when relevant) must be present during patient discussions to ensure comprehensive information on all treatment options 1

Evidence for Clinical Impact

Outcomes in Specific Conditions

• In lung cancer care, multidisciplinary team evaluation increases resection rates, rates of receiving chemotherapy or radiotherapy, and improves adherence to guidelines 1
• Patients evaluated by multidisciplinary teams are more likely to have histologic confirmation and referral for potentially curative treatment 1
• Team-based chronic care models focusing on multiple treatment targets are cost-effective and improve clinical outcomes 1, 2

Quality Improvements

• Integrated team evaluation is associated with improved practice patterns including pathologic diagnosis, complete staging, and shorter intervals from diagnosis to treatment 1
• The approach enables comprehensive risk assessment and benefit analysis, particularly valuable for marginal surgical candidates 1

Implementation Considerations

Communication Infrastructure

• Establish regular communication channels through daily interprofessional rounds, weekly meetings, electronic health records, email, text messages, or phone calls 3
• Use electronic health records and patient registries to identify patients with undiagnosed or undertreated conditions 3

Common Pitfalls to Avoid

• Avoid lengthy meetings with excessive caseloads - this reduces physician motivation to actively participate; instead, maintain frequent shorter meetings 1
• Do not allow traditional hierarchy to override clinical appropriateness - the most qualified specialist for the specific problem should lead that aspect of evaluation 1, 3
• Ensure all necessary disciplines are present - incomplete team composition compromises the evaluation's comprehensiveness 1

Resource Considerations

• While resource constraints exist, particularly in low- and middle-income countries, prevention through care reorganization and patient education is vital to prevent disease progression 1
• In high-income countries, system and financial barriers often lower care quality, requiring policymakers to build capacity and reward preventive care 1

Specific Applications

Chronic Disease Management

• For diabetes and chronic kidney disease, integrated team evaluation should include regular assessment, control of multiple risk factors, and self-management support to protect organ function and reduce complications 1
• Team-based models achieve multiple treatment targets simultaneously and are cost-saving 1

Complex Medical Conditions

• Stratify management complexity based on the number and severity of chronic conditions, functional status, treatment complexity, and patient preferences 2
• Conduct ongoing comprehensive medication reviews to reduce polypharmacy using tools like the Medication Regimen Complexity Index 2

Surgical Candidacy

• Integrated team evaluation is especially useful for marginal surgical candidates to discuss proposed procedures and treatment alternatives with patients and families 1
• The team shares responsibility for recommending optimal therapy, potentially minimizing medical malpractice exposure 1