Establishing a Multicenter Network for Patients With Thyroid Nodules and Cancer: Effects on Referral Patterns

Abstract

Objective To perform a qualitative evaluation of the Thyroid Network, with a quantitative analysis of second opinion referrals for patients in the southwestern part of the Netherlands who have thyroid nodules and cancer. Methods This prospective observational study registered all patients with thyroid nodules and cancer who were referred to the academic hospital from 2 years before and 4 years after the foundation of the Thyroid Network. We implemented biweekly regional multidisciplinary tumor boards using video conference and a regional patient care pathway for patients with thyroid nodules and cancer. For qualitative evaluation, interviews were conducted with a broad selection of stakeholders via maximum variation sampling. The primary outcome was the change in second opinions after the foundation of the Thyroid Network. Results Second opinions from Thyroid Network hospitals to the academic hospital decreased from 10 (30%) to 2 (7%) two years after the start of the Thyroid Network ( P = .001), while patient referrals remained stable (n = 108 to 106). Qualitative evaluation indicated that the uniform care pathway and the regional multidisciplinary tumor board were valued high. Discussion Establishing a regional network, including multidisciplinary tumor boards and a care pathway for patients with thyroid nodules and cancer, resulted in a decrease in second opinions of in-network hospitals and high satisfaction of participating specialists. Implications for Practice The concept of the Thyroid Network could spread to other regions as well as to other specialties in health care. Future steps would be to assess the effect of regional collaboration on quality of care and patient satisfaction.

Regional Collaboration and Trends in Clinical Management of Thyroid Cancer

“…This shift can be explained by the establishment of the Thyroid Network and its uniform care pathway which facilitates a standardized way of patient referral in the region. 9 These shifts are in line with a report from the Dutch Ministry of Health, which stressed the importance of centralization of health care. 13,23 Before the implementation of the Thyroid Network, several regional hospitals performed lymph node dissections for patients with thyroid cancer with a median of 1 per year per hospital.…”

“…The proportion of patients with high‐complex disease who were referred to the academic hospital remained high and stable over time (>85%), while more patients with low‐risk papillary thyroid carcinoma received care only in the regional hospitals. This shift can be explained by the establishment of the Thyroid Network and its uniform care pathway which facilitates a standardized way of patient referral in the region 9 . These shifts are in line with a report from the Dutch Ministry of Health, which stressed the importance of centralization of health care 13,23 .…”

“…These hospitals are currently all part of a regional oncological network centered around thyroid cancer; “the Thyroid Network,” which was established in January 2016. As previously described, 9 the foundation of the Thyroid Network was accompanied by the implementation of a biweekly regional multidisciplinary tumor board and uniform care pathway (Supplemental Additional File 1, available online) 13 . Detailed information about the foundation of the Thyroid Network can be found in Supplemental Additional File 2, available online.…”

“…7,8 Previously, we have demonstrated the impact of a regional network on referral patterns in patients with thyroid cancer. 9 That study showed a more efficient and structured way of patient referral and a decrease in unnecessary second opinions.…”

“…Interhospital collaboration also contributes to improved access to evidence‐based health care, 4‐6 new treatment options, and clinical studies 7,8 . Previously, we have demonstrated the impact of a regional network on referral patterns in patients with thyroid cancer 9 . That study showed a more efficient and structured way of patient referral and a decrease in unnecessary second opinions.…”