Abstract：
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.
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.
摘要：
目的：对甲状腺网络进行定性评估，对荷兰西南部甲状腺结节和癌症患者的第二意见推荐进行定量分析。
方法：这项前瞻性观察性研究登记了所有甲状腺结节和癌症患者，这些患者在甲状腺网络建立前2年和后4年转诊至学术医院。我们使用视频会议和甲状腺结节和癌症患者的区域患者护理路径，每两周实施一次区域多学科肿瘤委员会。对于定性评估，访谈是通过最大变异抽样与广泛选择的利益相关者进行的。主要结果是甲状腺网络建立后第二观点的变化。
结果：甲状腺网络开始两年后，甲状腺网络医院对学术医院的第二意见从10（30％）下降到2（7％）（P=0.001），而患者转诊保持稳定（n=108至106）。定性评价表明，统一护理路径和区域多学科肿瘤委员会的价值很高。
结论：建立区域网络，包括多学科肿瘤委员会和甲状腺结节和癌症患者的护理途径，导致网络内医院的第二意见减少，参与专家的满意度很高。
结论：甲状腺网络的概念可以传播到其他地区以及其他医疗保健专业。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。
方法：这项前瞻性观察性研究登记了所有甲状腺结节和癌症患者，这些患者在甲状腺网络建立前2年和后4年转诊至学术医院。我们使用视频会议和甲状腺结节和癌症患者的区域患者护理路径，每两周实施一次区域多学科肿瘤委员会。对于定性评估，访谈是通过最大变异抽样与广泛选择的利益相关者进行的。主要结果是甲状腺网络建立后第二观点的变化。
结果：甲状腺网络开始两年后，甲状腺网络医院对学术医院的第二意见从10（30％）下降到2（7％）（P=0.001），而患者转诊保持稳定（n=108至106）。定性评价表明，统一护理路径和区域多学科肿瘤委员会的价值很高。
结论：建立区域网络，包括多学科肿瘤委员会和甲状腺结节和癌症患者的护理途径，导致网络内医院的第二意见减少，参与专家的满意度很高。
结论：甲状腺网络的概念可以传播到其他地区以及其他医疗保健专业。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。
