American Head and Neck Society Endocrine Section clinical consensus statement: North American quality statements and evidence-based multidisciplinary workflow algorithms for the evaluation and management of thyroid nodules

Charles J Meltzer; Jonathan Irish; Peter Angelos; Naifa L Busaidy; Louise Davies; Sunshine Dwojak; Robert L Ferris; Bryan R Haugen; Richard M Harrell; Megan R Haymart; Bryan McIver; Jeffrey I Mechanick; Eric Monteiro; John C Morris 3rd; Luc G T Morris; Michael Odell; Joseph Scharpf; Ashok Shaha; Jennifer J Shin; David C Shonka Jr; Geoffrey B Thompson; R Michael Tuttle; Mark L Urken; Sam M Wiseman; Richard J Wong; Gregory Randolph

doi:10.1002/hed.25526

American Head and Neck Society Endocrine Section clinical consensus statement: North American quality statements and evidence-based multidisciplinary workflow algorithms for the evaluation and management of thyroid nodules

Head Neck. 2019 Apr;41(4):843-856. doi: 10.1002/hed.25526. Epub 2018 Dec 18.

Authors

Charles J Meltzer¹, Jonathan Irish², Peter Angelos³, Naifa L Busaidy⁴, Louise Davies^{5

6

7}, Sunshine Dwojak⁸, Robert L Ferris⁹, Bryan R Haugen¹⁰, Richard M Harrell¹¹, Megan R Haymart¹², Bryan McIver¹³, Jeffrey I Mechanick¹⁴, Eric Monteiro¹⁵, John C Morris 3rd¹⁶, Luc G T Morris¹⁷, Michael Odell¹⁸, Joseph Scharpf¹⁹, Ashok Shaha²⁰, Jennifer J Shin²¹, David C Shonka Jr²², Geoffrey B Thompson²³, R Michael Tuttle²⁴, Mark L Urken^{25

26

27}, Sam M Wiseman²⁸, Richard J Wong¹⁷, Gregory Randolph²⁹

Affiliations

¹ The Permanente Medical Group, Kaiser Permanente, Santa Rosa, California.
² Department of Otolaryngology, Head and Neck Surgery/Surgical Oncology, Princess Margaret Cancer Centre, University Health Network/University of Toronto, Toronto, Ontario, Canada.
³ Department of Surgery, MacLean Center for Clinical Ethics, The University of Chicago Medicine, Chicago, Illinois.
⁴ Department of Endocrine Neoplasia & Hormonal Disorders, The University of Texas MD Anderson Cancer Center, Houston, Texas.
⁵ The VA Outcomes Group, Department of Veterans Affairs Medical Center, White River Junction, Vermont.
⁶ Section of Otolaryngology, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire.
⁷ The Dartmouth Institute for Health Policy and Clinical Practice, Hanover, New Hampshire.
⁸ Northwest Permanente Medicine, Kaiser Permanente, Portland, Oregon.
⁹ Division of Head and Neck Surgery, Department of Otolaryngology, University of Pittsburgh Cancer Institute, Pittsburgh, Pennsylvania.
¹⁰ Division of Endocrinology, University of Colorado School of Medicine, Aurora, Colorado.
¹¹ Departments of Integrative Endocrine Surgery and Pathology, Memorial Healthcare System, Hollywood, Florida.
¹² Division of Metabolism, Endocrinology, and Diabetes, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan.
¹³ Department of Biostatistics and Bioinformatics, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida.
¹⁴ Divisions of Cardiology and Endocrinology, Diabetes and Bone Disease, Icahn School of Medicine at Mount Sinai, Mount Sinai School of Medicine, New York, New York.
¹⁵ Department of Otolaryngology-Head and Neck Surgery, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada.
¹⁶ Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, Minnesota.
¹⁷ Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York.
¹⁸ Department of Otolaryngology-Head and Neck Surgery, The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada.
¹⁹ Department of Otolaryngology-Head and Neck Surgery, Head and Neck Institute, Cleveland Clinic, Cleveland, Ohio.
²⁰ Department of Surgery, Head and Neck Service, Memorial Sloan Kettering Cancer Center, New York, New York.
²¹ Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts.
²² Department of Otolaryngology-Head and Neck Surgery, University of Virginia Health System, Charlottesville, Virginia.
²³ Departments of Surgery, Mayo Clinic, Rochester, Minnesota.
²⁴ Department of Medicine, Endocrinology Service, Memorial Sloan Kettering Cancer Center, New York, New York.
²⁵ Department of Otolaryngology Head and Neck Surgery, Mount Sinai Beth Israel, New York, New York.
²⁶ Icahn School of Medicine, Mount Sinai, New York, New York.
²⁷ Thyroid, Head and Neck Cancer Foundation, New York, New York.
²⁸ Department of Surgery, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada.
²⁹ Department of Otolaryngology, Massachusetts General Hospital, Boston, Massachusetts.

PMID: 30561068
DOI: 10.1002/hed.25526

Abstract

Background: Care for patients with thyroid nodules is complex and multidisciplinary, and research demonstrates variation in care. The objective was to develop clinical guidelines and quality metrics to reduce unwarranted variation and improve quality.

Methods: Multidisciplinary expert consensus and modified Delphi approach. Source documents were workflow algorithms from Kaiser Permanente Northern California and Cancer Care of Ontario based on the 2015 American Thyroid Association management guidelines for adult patients with thyroid nodules and differentiated thyroid cancer.

Results: A consensus-based, unified preoperative, perioperative, and postoperative workflow was developed for North American use. Twenty-one panelists achieved consensus on 16 statements about workflow-embedded process and outcomes metrics addressing safety, access, appropriateness, efficiency, effectiveness, and patient centeredness of care.

Conclusion: A panel of Canadian and United States experts achieved consensus on workflows and quality metric statements to help reduce unwarranted variation in care, improving overall quality of care for patients diagnosed with thyroid nodules.

Keywords: differentiated thyroid carcinoma; quality of care; thryoidectomy; thyroid; thyroid nodules.

Publication types

Review

MeSH terms

Algorithms
Consensus
Delphi Technique
Evidence-Based Medicine
Female
Head and Neck Neoplasms
Humans
Interdisciplinary Communication
Male
North America
Postoperative Care / standards
Practice Guidelines as Topic*
Preoperative Care / standards
Quality Improvement*
Societies, Medical
Thyroid Neoplasms / pathology
Thyroid Neoplasms / surgery*
Thyroid Nodule / pathology
Thyroid Nodule / surgery*
Thyroidectomy / methods*
Workflow*