Original article
Care and economic impact of thyroid ultrasound examination at single visits to endocrinology clinics (the ETIEN 1 study)
Impacto asistencial y económico de la ecografía tiroidea en acto único en consultas de endocrinología (estudio ETIEN 1)
Florentino Carral
, María del Carmen Ayala, Ana Isabel Jiménez, Concepción García
Corresponding author
Unidad de Gestión Clínica de Endocrinología y Nutrición, Hospital Universitario Puerto Real, Cádiz, Spain
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=> "Jiménez" ] 3 => array:2 [ "nombre" => "Concepción" "apellidos" => "García" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Unidad de Gestión Clínica de Endocrinología y Nutrición, Hospital Universitario Puerto Real, Cádiz, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Impacto asistencial y económico de la ecografía tiroidea en acto único en consultas de endocrinología (estudio ETIEN 1)" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 833 "Ancho" => 1642 "Tamanyo" => 75652 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Change in thyroid US performed at the hospital during the study period (2011–2014).</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Thyroid disease currently represents one of the main reasons for referral to endocrinology outpatient clinics<a class="elsevierStyleCrossRefs" href="#bib0120"><span class="elsevierStyleSup">1,2</span></a> because of both the high prevalence of thyroid conditions in the general population<a class="elsevierStyleCrossRefs" href="#bib0130"><span class="elsevierStyleSup">3,4</span></a> and the expansion of hormone measurements and imaging procedures, which have led to a marked increase in the detection of both impaired thyroid function and incidentalomas in the thyroid gland.<a class="elsevierStyleCrossRefs" href="#bib0125"><span class="elsevierStyleSup">2,4</span></a> While approximately 4%–7% of the general population has palpable thyroid nodules, imaging tests reveal nodules in up to 20%–70% of the population.<a class="elsevierStyleCrossRefs" href="#bib0135"><span class="elsevierStyleSup">4,5</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Thyroid ultrasonography (US) is the most important imaging procedure for diagnosing thyroid disease.<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">5</span></a> US has evolved in recent years thanks to the design of increasingly compact and manageable equipment with improved quality and definition. This has allowed for the increasing use of this equipment at clinics, rather than at radiodiagnosis units.<a class="elsevierStyleCrossRefs" href="#bib0145"><span class="elsevierStyleSup">6,7</span></a> The performance of thyroid US at single visits to endocrinology clinics might therefore be expected to lead to cost reductions by reducing the number of visits necessary–both to the radiodiagnosis unit for the performance of thyroid US and subsequently to the endocrinology clinic a second time to be given the results. However, this has not been confirmed by clinical studies.</p><p id="par0015" class="elsevierStylePara elsevierViewall">Following the model of the Thyroid Core Group of the Mayo Clinic,<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">8</span></a> the endocrinology unit of our center has been performing thyroid US since January 2013. Patients are only referred to the radiodiagnosis unit for more comprehensive US in the event of difficult or doubtful diagnosis. This model of care at a single visit to the endocrinology clinic (with clinical, hormonal, and US assessment by the endocrinologist on the same day) is still uncommon in Spain<a class="elsevierStyleCrossRefs" href="#bib0145"><span class="elsevierStyleSup">6,7</span></a> and coexists with the predominant organizational model, in which patients are evaluated by the endocrinologist, who requests US or US-guided fine-needle aspiration (US-FNA) of the thyroid gland, which is then performed on a different day and whose results are assessed by the endocrinologist at another visit (thus patients usually have to attend the center on three different days).<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">9</span></a> It is therefore necessary to assess whether thyroid US at a single visit to the endocrinology clinic allows for direct savings in costs by reducing the number of appointments, both to the radiodiagnosis unit and subsequently to endocrinology.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Methods</span><p id="par0020" class="elsevierStylePara elsevierViewall">The Thyroid Ultrasound in Endocrinology (ETIEN) study was designed in January 2013 as a prospective, observational, descriptive study intended to assess the clinical results and the care and economic impact of the implementation of thyroid US at single visits to the endocrinology outpatient clinics of Hospital Universitario Puerto Real in Cádiz, Spain. The purpose of the ETIEN 1 substudy was to assess the economic impact of the use of thyroid US at a single visit during the first two years (2013 and 2014) of its implementation. The 2274 patients (mean age, 59<span class="elsevierStyleHsp" style=""></span>+/−<span class="elsevierStyleHsp" style=""></span>16 years; 83% females) seen at the endocrinology unit for thyroid disease who had at least one US performed at endocrinology clinics during 2013 and 2014 were considered candidates for inclusion in the analysis.</p><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Thyroid disease assessment</span><p id="par0025" class="elsevierStylePara elsevierViewall">Since 2010, the approach to the diagnosis of thyroid nodule and dysfunction at our hospital has been based on a protocol that coordinates the activities of the endocrinology, radiodiagnosis, general surgery, and pathology departments. The protocol was revised on 2012 and 2014, and annual evaluations have shown a high level of compliance. The criteria for the referral of patients with thyroid disease (thyroid dysfunction and nodule) to endocrinology clinics are in accord with those for primary care and include the need for previous TSH measurement to characterize thyroid hormone function before referral.</p><p id="par0030" class="elsevierStylePara elsevierViewall">Patients with thyroid disease (suspected or documented) are usually referred to our unit by primary care or other specialties, and are assessed by an endocrinologist from the unit. Until January 2013, both thyroid US and US-FNA were performed exclusively at the radiodiagnosis unit of the hospital, but after that date, the performance of thyroid US and US-FNA at single visits to endocrinology clinics was gradually introduced. Thus, by the end of 2014, approximately 81% of all thyroid US tests performed on our patients were done by endocrinologists at the clinic itself. All the US tests at the unit were performed using digital portable Sonosite Micromax US equipment with a 6–13<span class="elsevierStyleHsp" style=""></span>Mhz broadband linear transducer. In order to prevent bias in the indication of thyroid US, there were no restrictions on indicating US in any of the periods evaluated, and endocrinologists used their clinical judgment to decide both the indication of the procedure and whether they would perform it themselves or request it from radiodiagnosis. The main indications were thyroid nodules, goiter, and thyroid cancer follow-up.</p><p id="par0035" class="elsevierStylePara elsevierViewall">In our unit, patients with no significant disease, hormonally stabilized, and with no criteria for performing US-FNA or surgical exploration are discharged on the same day (direct discharge visit with no review of results), while all other patients are appointed for a review of hormone and/or cytological results (if thyroid US-FNA has been requested). Finally, patients with thyroid nodules who are candidates for thyroidectomy are referred to the surgical unit, while patients with no surgical criteria and hormonal stability are discharged.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Study variables and cost saving estimation</span><p id="par0040" class="elsevierStylePara elsevierViewall">The variables analyzed included age, sex, place of origin, the number of thyroid US tests and US-FNAs performed at the unit and the type of visit (a visit to a high-performance clinic with no review of the results or a single visit with a subsequent appointment for a review). The radiodiagnosis unit provided information on the number of thyroid US tests requested by physicians from the unit in the 2011–2014 period, and on the total number of thyroid US and US-FNAs performed by the radiodiagnosis unit during the same period.</p><p id="par0045" class="elsevierStylePara elsevierViewall">To estimate the potential financial savings using the model of the single endocrinology visit, only the direct costs of health care not performed were considered. These included both the cost of a thyroid US that would theoretically have been performed at the radiodiagnosis unit and the cost of control at endocrinology of patients attending a direct discharge visit with no subsequent review of the results. Direct costs were calculated using the prices listed in the order of October 14, 2005 of the Department of Health of the government of Andalusia that established the public prices of the health services provided by centers dependent on the Andalusian public health system.<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">10</span></a> A cost sensitivity analysis was subsequently carried out to assess the economic consequences of the impact of changes in the set prices by a simple univariate analysis of minimum and maximum costs<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">11</span></a> using the updated reference prices in five Spanish autonomous communities.<a class="elsevierStyleCrossRefs" href="#bib0175"><span class="elsevierStyleSup">12–16</span></a></p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Statistical analysis</span><p id="par0050" class="elsevierStylePara elsevierViewall">Patient data were entered into a database of the Microsoft Access 2007 database, and statistical analysis was performed using the Statistical Package for the Social Sciences version 11.0. Continuous variables were displayed as mean<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>standard deviation, while qualitative variables were given as absolute and relative frequencies (percentages). The results of sensitivity analysis for financial costs are given as a range of the minimum and maximum costs, based on the different reference prices of thyroid US and control visits to endocrinologists established in the autonomous communities evaluated.</p></span></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Results</span><p id="par0055" class="elsevierStylePara elsevierViewall">During 2013 and 2014, 2558 thyroid US tests were performed at endocrinology clinics, with a 17% increase in 2014 as compared to 2013 (1382 versus 1176). Of all US tests, 42.3% were performed at a single visit with direct discharge and no appointment for a review of the results (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>), while in the remaining 57.7% of cases at least one subsequent appointment was required for further study after diagnostic tests were requested, including thyroid US-FNA, performed in 452 patients.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0060" class="elsevierStylePara elsevierViewall">The number of thyroid US tests requested from the radiodiagnosis unit by endocrinologists decreased in parallel, so that, as compared to 2012 (before thyroid US was implemented at endocrinology clinics), the number of thyroid US tests requested decreased by 43% and 86% in 2013 and 2014 respectively (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>). In this regard, it should be noted that in 2014, 2042 fewer US tests were requested from the radiodiagnosis unit as compared to 2012.</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0065" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a> shows the change over time in thyroid US performed at our hospital between 2011 and 2014. While 100% of thyroid US tests were carried out at the radiodiagnosis unit during 2011 and 2012, only 65.7% and 41.9% of all procedures were performed there in 2013 and 2014 respectively. On the other hand, while in 2013 the total number of thyroid US procedures performed at the hospital increased by 9.4% as compared to 2012, a 24.2% reduction occurred in 2014.</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0070" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> shows the potential direct financial savings derived only from the non-performance of thyroid US at the radiodiagnosis unit and the non-appointment for a subsequent visit to the endocrinology clinic for a review of the results. Savings estimated in 2013 and 2014 were €94,441.36 (cost range in the sensitivity analysis: €51,160.00–168,802.44), derived from the non-performance of 2558 thyroid US tests at the radiodiagnosis unit, and €58,946.40 (cost range in the sensitivity analysis: €44.895,60–147.549,60) from the avoidance of 1080 visits to endocrinology clinics for a review of the results.</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Discussion</span><p id="par0075" class="elsevierStylePara elsevierViewall">High-performance (or single visit) outpatient clinics aim at resolving the health problem of a patient on the same day of the visit by performing the supplemental tests adequate for that purpose. High-performance cardiology clinics, introduced throughout Spain and performing most supplemental examinations required for patient work-up (electrocardiogram, echocardiogram, etc.), are a good example of this approach and have proven positive efficiency results.<a class="elsevierStyleCrossRefs" href="#bib0200"><span class="elsevierStyleSup">17,18</span></a></p><p id="par0080" class="elsevierStylePara elsevierViewall">Thyroid disease is among the most common reasons for referral to endocrinology clinics,<a class="elsevierStyleCrossRefs" href="#bib0120"><span class="elsevierStyleSup">1,2</span></a> at which US to detect goiter or thyroid nodules, or US-FNA to rule out thyroid cancer, present in approximately 5% of thyroid nodules, may be required.<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">19</span></a> A one-stop clinic where the endocrinologist integrates clinical, hormonal, and US information from the patient in a single visit, and decides the most adequate therapeutic approach, has been shown to be cost-effective and efficient for decreasing waiting times.<a class="elsevierStyleCrossRefs" href="#bib0145"><span class="elsevierStyleSup">6,7</span></a> However, this organizational model is little used in Spain<a class="elsevierStyleCrossRefs" href="#bib0160"><span class="elsevierStyleSup">9,20</span></a> and coexists with other models in which patients undergo clinical and hormonal evaluation by the endocrinologist and US by the radiologist.<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">21</span></a> This requires greater coordination between units and more frequent visits by patients to the healthcare center, which significantly impairs system efficiency.<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">22</span></a> As an example, a patient who attends an endocrinology one-stop clinic and undergoes thyroid US, but requires no additional appointment for a review of the results incurs in our autonomous community a theoretical cost of €114.12 (first visit).<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">10</span></a> By contrast, the “theoretical invoice” with the model of a first visit to endocrinology (€114.12), plus thyroid US at the radiodiagnosis unit (€36.92) plus a visit to endocrinology for review of results (€54.59), would amount to €205.63.</p><p id="par0085" class="elsevierStylePara elsevierViewall">The results of this study support the concept that a one-stop or high-performance clinic for thyroid disease incorporating thyroid US or US-FNA represents an alternative to other organizational systems that improves the efficiency of the health system. This approach requires ultrasound equipment to be purchased or transferred from radiodiagnosis units, but this financial investment is rapidly compensated by savings in US performed by the radiodiagnosis unit, estimated in our study at €94,441 in two years (€51,160.00–168,802.44 in sensitivity analysis). In addition, a decrease in the number of thyroid US tests requested from radiodiagnosis units could make possible a reduction in the waiting times for other US procedures requested by other specialties. Moreover, a one-stop clinic allows for improvements in the management of endocrinology clinics by decreasing the number of unnecessary appointments for the collection of US results, with potential savings estimated in our study of €58,946.40 in two years (€44,895.60–147,549.60 in the sensitivity analysis).</p><p id="par0090" class="elsevierStylePara elsevierViewall">As this was a study analyzing direct costs, this research did not consider the potential economic savings to be derived from decreased expenses for travel to the center or for less time off work, among other factors. Finally, patient satisfaction is likely to increase, because waiting times are markedly decreased, the indirect costs associated with subsequent visits are reduced, and anxiety caused by delays in diagnosis and treatment is minimized.<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">23</span></a></p><p id="par0095" class="elsevierStylePara elsevierViewall">To conclude, thyroid US at endocrinology clinics makes it possible to reduce both the number of thyroid US tests requested from and performed by the radiodiagnosis unit and the number of return visits to the endocrinology clinic to find out the results, thus decreasing unnecessary patient travel and promoting substantial economic savings.</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Conflicts of interest</span><p id="par0100" class="elsevierStylePara elsevierViewall">The authors of this article have no conflicts of interests in relation to the objective or the results of this article.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:11 [ 0 => array:3 [ "identificador" => "xres618593" "titulo" => "Abstract" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Objective" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec632617" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres618594" "titulo" => "Resumen" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Objetivo" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec632618" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:3 [ "identificador" => "sec0010" "titulo" => "Methods" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0015" "titulo" => "Thyroid disease assessment" ] 1 => array:2 [ "identificador" => "sec0020" "titulo" => "Study variables and cost saving estimation" ] 2 => array:2 [ "identificador" => "sec0025" "titulo" => "Statistical analysis" ] ] ] 6 => array:2 [ "identificador" => "sec0030" "titulo" => "Results" ] 7 => array:2 [ "identificador" => "sec0035" "titulo" => "Discussion" ] 8 => array:2 [ "identificador" => "sec0040" "titulo" => "Conflicts of interest" ] 9 => array:2 [ "identificador" => "xack208214" "titulo" => "Acknowledgment" ] 10 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2015-07-01" "fechaAceptado" => "2015-10-30" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec632617" "palabras" => array:4 [ 0 => "Thyroid ultrasound" 1 => "Endocrinology" 2 => "Single appointment" 3 => "Cost savings" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec632618" "palabras" => array:4 [ 0 => "Ecografía tiroidea" 1 => "Endocrinología" 2 => "Acto único" 3 => "Ahorro de costes" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Objective</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Routine thyroid ultrasound examination in a single medical appointment is rarely performed in Spain. The objective of this study was to evaluate the care and economic impact of thyroid US examination in a single endocrine appointment.</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">A prospective, observational, descriptive study was conducted to analyze data from 2274 patients (mean age, 59<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>16 years; 83% females) performed at least one thyroid US in a single visit to an endocrinology clinic during 2013 and 2014. The number of endocrine acts with thyroid US, single endocrine and US acts without review, and the change in the number of thyroid US requested by endocrinologists to the radiology department and total thyroid US examinations performed at the radiology department during the study period were assessed.</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">In 2013 and 2014, 2558 endocrine acts with thyroid US were performed, of which 42.2% were single endocrine and US appointments without a second endocrine act, with estimated savings of €58,946.40. As compared to 2012, the number of thyroid US requested by endocrinologists to the radiology department decreased by 43.3% and 86.0% in 2013 and 2014 respectively, and total thyroid US performed by the radiology department decreased by 28.1% and 68.3% respectively, with estimated savings of €94,441.36.</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Thyroid US examination in a single endocrine appointment allows for decreasing the number of both second endocrine acts and thyroid US examinations performed at the radiology department, thus reducing the number of unnecessary clinic visits and promoting considerable economic savings.</p></span>" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Objective" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Objetivo</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">La realización de ecografía tiroidea en consultas en acto único está escasamente implantada en nuestro país. El objetivo de este estudio fue evaluar el impacto asistencial y económico de la utilización de la ecografía tiroidea en consultas de endocrinología en acto único.</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Métodos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Se trata de un estudio prospectivo, observacional y descriptivo en el que se analizaron los datos de 2.274 pacientes (edad media: 59<span class="elsevierStyleHsp" style=""></span>+/-<span class="elsevierStyleHsp" style=""></span>16 años; 83% mujeres) a los cuales se les realizó al menos una ecografía tiroidea en acto único en consultas de endocrinología durante 2013 y 2014. Se evaluaron el número de consultas de acto único, consultas con alta directa y la variación en el número de ecografías solicitadas y realizadas en radiodiagnóstico durante el período de estudio.</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">En 2013 y 2014 se realizaron 2.558 ecografías tiroideas en consultas de endocrinología en acto único, siendo el 42,2% consultas de alta directa sin revisión de resultados, con un ahorro estimado de 58.946,40 euros. En 2013 y 2014 se redujo el número de ecografías solicitadas a radiodiagnóstico en un 43,3% y 86,0%, respectivamente. De forma global se realizaron en radiodiagnóstico un 28,1% y un 68,3% menos ecografías tiroideas respecto al año 2012, estimándose un ahorro económico de 94.441,36 euros.</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusiones</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">La realización de ecografías tiroideas en consultas de endocrinología en acto único permite reducir tanto el número de revisiones de recogida de resultados como las ecografías tiroideas realizadas en radiodiagnóstico, lo cual disminuye el número de desplazamientos innecesarios de pacientes y favorece un ahorro económico considerable.</p></span>" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Objetivo" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0020">Please cite this article as: Carral F, Ayala MC, Jiménez AI, García C. Impacto asistencial y económico de la ecografía tiroidea en acto único en consultas de endocrinología (estudio ETIEN 1). Endocrinol Nutr. 2016;63:64–69.</p>" ] ] "multimedia" => array:4 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1121 "Ancho" => 1637 "Tamanyo" => 84972 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Change over time in thyroid US performed at endocrinology clinics during the study period. US: ultrasonograpy; US-FNA: US-guided fine-needle aspiration.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1620 "Ancho" => 2306 "Tamanyo" => 119358 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Change in requests by endocrinologists for thyroid US from the radiodiagnosis unit during the study period.</p>" ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 833 "Ancho" => 1642 "Tamanyo" => 75652 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Change in thyroid US performed at the hospital during the study period (2011–2014).</p>" ] ] 3 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:3 [ "leyenda" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">€: euro; US: ultrasonography; RD: radio-diagnosis.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Concept \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">No. \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Costs saved (€)<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Minimum costs (€)<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Maximum costs (€)<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">c</span></a> \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " colspan="5" align="left" valign="top"><span class="elsevierStyleItalic">Thyroid US not requested from RD</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">2013 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1176 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">43,417.92 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">23,520.00 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">77,604.24 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">2014 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1382 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">51,023.44 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">27,640.00 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">91,198.18 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Total \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2558 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">94,441.36 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">51,160.00 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">168,802.44 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="5" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="5" align="left" valign="top"><span class="elsevierStyleItalic">Endocrinology visits avoided</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">2013 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">462 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">25,215.96 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">19,205.34 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">63,118.44 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">2014 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">618 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">33,730.44 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">25,690.26 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">84,431.16 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Total \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1080 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">58,946.40 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">44,895.60 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">147,549.60 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1012689.png" ] ] ] "notaPie" => array:3 [ 0 => array:3 [ "identificador" => "tblfn0005" "etiqueta" => "a" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Cost of ultrasonography; €36.92<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">10</span></a>; cost of review: €54.58.<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">10</span></a></p>" ] 1 => array:3 [ "identificador" => "tblfn0010" "etiqueta" => "b" "nota" => "<p class="elsevierStyleNotepara" id="npar0010">Cost of ultrasonography: 20.00 euros<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">15</span></a>; cost of review: €41.57.<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">15</span></a></p>" ] 2 => array:3 [ "identificador" => "tblfn0015" "etiqueta" => "c" "nota" => "<p class="elsevierStyleNotepara" id="npar0015">Cost of ultrasonography: €65.99<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">13</span></a>; cost of review: €136.62.<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">14</span></a></p>" ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Estimate of the potential savings in direct costs in the model of ultrasonography at single visits to endocrinology clinics during the study period.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:23 [ 0 => array:3 [ "identificador" => "bib0120" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Sistema de consultoría virtual entre la atención endocrinológica especializada y la atención primaria" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "X. 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|---|---|---|---|
| 2024 November | 3 | 0 | 3 |
| 2024 October | 18 | 2 | 20 |
| 2024 September | 48 | 4 | 52 |
| 2024 August | 25 | 6 | 31 |
| 2024 July | 16 | 6 | 22 |
| 2024 June | 18 | 4 | 22 |
| 2024 May | 19 | 4 | 23 |
| 2024 April | 20 | 2 | 22 |
| 2024 March | 46 | 2 | 48 |
| 2024 February | 31 | 6 | 37 |
| 2024 January | 15 | 2 | 17 |
| 2023 December | 28 | 16 | 44 |
| 2023 November | 21 | 7 | 28 |
| 2023 October | 33 | 11 | 44 |
| 2023 September | 13 | 3 | 16 |
| 2023 August | 9 | 5 | 14 |
| 2023 July | 7 | 9 | 16 |
| 2023 June | 11 | 1 | 12 |
| 2023 May | 5 | 3 | 8 |
| 2023 April | 14 | 3 | 17 |
| 2023 March | 9 | 1 | 10 |
| 2023 February | 14 | 6 | 20 |
| 2023 January | 21 | 3 | 24 |
| 2022 December | 14 | 6 | 20 |
| 2022 November | 21 | 11 | 32 |
| 2022 October | 20 | 10 | 30 |
| 2022 September | 22 | 21 | 43 |
| 2022 August | 22 | 20 | 42 |
| 2022 July | 15 | 7 | 22 |
| 2022 June | 18 | 7 | 25 |
| 2022 May | 15 | 6 | 21 |
| 2022 April | 24 | 7 | 31 |
| 2022 March | 34 | 5 | 39 |
| 2022 February | 44 | 13 | 57 |
| 2022 January | 35 | 10 | 45 |
| 2021 December | 22 | 7 | 29 |
| 2021 November | 19 | 14 | 33 |
| 2021 October | 26 | 17 | 43 |
| 2021 September | 18 | 10 | 28 |
| 2021 August | 16 | 13 | 29 |
| 2021 July | 38 | 11 | 49 |
| 2021 June | 19 | 12 | 31 |
| 2021 May | 27 | 4 | 31 |
| 2021 April | 90 | 24 | 114 |
| 2021 March | 38 | 6 | 44 |
| 2021 February | 42 | 12 | 54 |
| 2021 January | 36 | 13 | 49 |
| 2020 December | 29 | 11 | 40 |
| 2020 November | 24 | 7 | 31 |
| 2020 October | 16 | 8 | 24 |
| 2020 September | 27 | 10 | 37 |
| 2020 August | 19 | 6 | 25 |
| 2020 July | 24 | 18 | 42 |
| 2020 June | 21 | 8 | 29 |
| 2020 May | 25 | 8 | 33 |
| 2020 April | 13 | 4 | 17 |
| 2020 March | 15 | 14 | 29 |
| 2020 February | 43 | 11 | 54 |
| 2020 January | 21 | 1 | 22 |
| 2019 December | 21 | 12 | 33 |
| 2019 November | 20 | 5 | 25 |
| 2019 October | 17 | 1 | 18 |
| 2019 September | 22 | 7 | 29 |
| 2019 August | 14 | 2 | 16 |
| 2019 July | 18 | 24 | 42 |
| 2019 June | 51 | 20 | 71 |
| 2019 May | 144 | 37 | 181 |
| 2019 April | 36 | 12 | 48 |
| 2019 March | 14 | 5 | 19 |
| 2019 February | 17 | 11 | 28 |
| 2019 January | 12 | 8 | 20 |
| 2018 December | 20 | 2 | 22 |
| 2018 November | 18 | 4 | 22 |
| 2018 October | 20 | 5 | 25 |
| 2018 September | 13 | 6 | 19 |
| 2018 August | 9 | 1 | 10 |
| 2018 July | 14 | 2 | 16 |
| 2018 June | 19 | 0 | 19 |
| 2018 May | 12 | 3 | 15 |
| 2018 April | 3 | 0 | 3 |
| 2018 March | 8 | 0 | 8 |
| 2018 February | 13 | 0 | 13 |
| 2018 January | 6 | 0 | 6 |
| 2017 December | 9 | 1 | 10 |
| 2017 November | 8 | 0 | 8 |
| 2017 October | 12 | 1 | 13 |
| 2017 September | 15 | 2 | 17 |
| 2017 August | 21 | 1 | 22 |
| 2017 July | 9 | 0 | 9 |
| 2017 June | 15 | 1 | 16 |
| 2017 May | 30 | 1 | 31 |
| 2017 April | 26 | 0 | 26 |
| 2017 March | 46 | 1 | 47 |
| 2017 February | 31 | 1 | 32 |
| 2017 January | 19 | 1 | 20 |
| 2016 December | 18 | 3 | 21 |
| 2016 November | 21 | 2 | 23 |
| 2016 October | 41 | 6 | 47 |
| 2016 September | 37 | 2 | 39 |
| 2016 August | 23 | 0 | 23 |
| 2016 May | 0 | 1 | 1 |
| 2016 April | 2 | 0 | 2 |
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