Improving fine needle aspiration in value-based thyroid cancer care: an interrupted time series analysis.

Abstract

Background: Value-Based Health Care (VBHC) implementation motivates providers to reduce unnecessary procedures to improve outcomes and costs, i.e.

Value: In thyroid cancer care, adequate use of Fine Needle Aspiration (FNA) may prevent downstream diagnostics, costs, and delays in the care process. This study aims to evaluate the impact of needle selection in FNA on Bethesda I classifications, duration of FNA appointments, and care utilization.

Methods: In October 2021, a Modified Menghini-type needle needle replaced the regular syringe needle used for FNA. An interrupted time series (ITS) analysis using generalized linear models was conducted with data from radiology and pathology reports coupled with care utilization data at the patient level. Outcomes included frequency of Bethesda I classifications per month, appointment time, and health care utilization in the first patient year (in 2024€).

Results: Between July 2020 and May 2022, 345 FNA in 224 patients were included. Implementation of the Modified Menghini-type needle needle was associated with a 78% level decrease in the odds of Bethesda I classification during FNA (OR (95% CI) 0.22 (0.06;0.71)), and, on average, a 4% (1.25 min) reduction in FNA appointment time. Despite a higher FNA unit cost postintervention (additional cost of €17.56 per FNA), there were no changes in the diagnostic and overall costs.

Conclusion: VBHC implementation provides the tools to identify and monitor improvement projects that enhance the value of thyroid nodule diagnostics and management. Implementing a Modified Menghini-type needle needle in FNA resulted in increased adequate diagnostic results, time savings, and no changes in diagnostic and care costs.

Clinical trial number: Not applicable.