Development of the First Quality Assessment Framework for the Endocarditis Multidisciplinary Team Meeting

Endocarditis is increasing in incidence with substantial morbidity and mortality. The endocarditis multidisciplinary team (MDT) is a core guideline recommendation with clear patient outcome benefits by expediting diagnosis, coordinating investigations and management. There is significant variability in content and specialist input, with no validated metric available to assess decision-making or demonstrate improvement over time. Multidisciplinary Team Metric for the Observation of Decision-making (MDT-MODe) is a validated quality assessment tool extensively utilized for cancer MDTs. This paper describes the adaptation of the psychometrically tested MDT-MODe to an endocarditis setting, resulting in the development of MDT-MODIE (Metric for the Observation of Decision-making for Infective Endocarditis).

An expert interview panel was engaged at a single high-volume London centre. Domains were assessed and analysed using a content validity index, through which the final MDT-MODIE was defined. Feasibility testing was conducted during MDTs between September 2024 and April 2025. Inter-rater reliability was assessed using intraclass correlation coefficients (ICCs), while internal validation was evaluated through point-biserial correlation coefficients. Statistical analyses were performed using IBM SPSS Statistics (version 29.0).

Domains scored as excellent or good were included in MDT-MODIE. Feasibility and reliability testing was performed with 152 patient discussions assessed, and scores matched to decision outcomes for each patient. Inter-rater reliability was confirmed across all domains (P < .001). Internal validation demonstrated a positive correlation between overall MODIE scores and MDT decision-making outcomes (rpb(96) = 0.216, P = .033).

Metric for the Observation of Decision-making for Infective Endocarditis provides a reliable framework for evaluating endocarditis MDT decision-making, which has undergone preliminary validation. It addresses a key gap in the literature, supporting cardiac centres in assessing the quality of guideline-recommended MDTs and monitoring improvement over time.