Department of Surgical Oncology and Gastrointestinal Surgery, Erasmus MC Cancer Institute, Rotterdam, the Netherlands.
Erasmus Centre for Healthcare Governance, Erasmus School of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, the Netherlands.
Otolaryngol Head Neck Surg. 2023 Jan;168(1):91-100. doi: 10.1177/01945998221086203.
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.
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.
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.
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.
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.
对甲状腺网络进行定性评估，并对荷兰西南部有甲状腺结节和癌症的患者的第二诊疗意见转诊进行定量分析。
这项前瞻性观察研究登记了所有从甲状腺网络成立前 2 年到成立后 4 年期间被转诊到学术医院的甲状腺结节和癌症患者。我们通过视频会议实施了两周一次的区域多学科肿瘤委员会，并为甲状腺结节和癌症患者制定了区域患者护理路径。为了进行定性评估，通过最大差异抽样对广泛的利益相关者进行了访谈。主要结果是甲状腺网络成立后第二诊疗意见的变化。
甲状腺网络医院向学术医院的第二诊疗意见从网络启动后两年的 10 例（30%）减少到 2 例（7%）（P =.001），而患者转诊保持稳定（n = 108 至 106）。定性评估表明，统一的护理路径和区域多学科肿瘤委员会受到高度重视。
建立一个包括甲状腺结节和癌症患者多学科肿瘤委员会和护理路径的区域网络，导致网络内医院的第二诊疗意见减少，参与专家的满意度高。
甲状腺网络的概念可以扩展到其他地区以及医疗保健的其他专业。未来的步骤将是评估区域合作对护理质量和患者满意度的影响。
