Impact of electronic consultation (e-consult) on timeliness and guideline concordance of workups leading to thyroid nodule fine-needle aspiration biopsy
Recommended Citation
Yoon SS, Wong DH, Wormwood JB, Reisman JI, Vimalananda VG. Impact of Electronic Consultation on Timeliness and Guideline Concordance of Workups Leading to Thyroid Nodule Fine-Needle Aspiration Biopsy. Endocr Pract. 2021;27(10):1011-1016. doi:10.1016/j.eprac.2021.03.008
Abstract
OBJECTIVE: Electronic consultations (e-consults) are commonly used to obtain endocrinology input on clinical questions without a face-to-face visit, but there are sparse data on quality of care resulting from e-consults for specific conditions. We examined workups resulting in thyroid nodule fine-needle aspiration (FNA) biopsy to examine whether endocrinology e-consults were more timely and similarly guideline concordant as compared to endocrinology face-to-face visits, and whether endocrinology e-consults were more guideline concordant as compared to workups without endocrinology input.
METHODS: We conducted a retrospective chart review of 302 thyroid FNA biopsies conducted in the Veterans Affairs (VA) health system between 5/1/2017 and 2/4/2020 (e-consult, N=99; face-to-face visit, N=100; no endocrinology input, N=103). We used t-tests to compare timeliness and chi-square tests to compare the proportion of guideline-concordant workups. We used multivariable linear and logistic models to control for demographic factors.
RESULTS: FNAs preceded by endocrinology e-consult had more timely workups compared to those preceded by endocrinology face-to-face visits in terms of days elapsed between referral and FNA biopsy [geometric mean [95% confidence interval]: 44.7 [37.2, 53.7] days vs. 61.7 [52.5, 72.4] days, t(195)=2.55, P=0.01]. The difference in the summary measure of guideline concordance across groups was not statistically significant (P=0.38).
CONCLUSION: E-consults were faster than face-to-face consults and similar guideline concordant as compared to both face-to-face consults and no endocrinology input for workups resulting in FNA. Decisions about appropriate use of e-consults for thyroid nodules should account for these data while also considering potential benefits of direct patient-endocrinologist interaction for complex situations.
Document Type
Article
PubMed ID
33766654
Affiliations
Division of Endocrinology, Diabetes, and Metabolism, Aurora Wilkinson Medical Clinic