Date of Award


Document Type


Degree Name

Doctor of Health Administration


College of Health Professions

First Advisor

Kit N. Simpson

Second Advisor

Jay Bronner

Third Advisor

Thomas Jay Crawford

Fourth Advisor

Zoher F. Kapasi


The primary objective of this study was to determine the impact of report recommendation on follow-up ultrasound studies in the work-up of incidental thyroid nodules. Secondary objective was to determine the rate of cost savings, number of missed thyroid cancers avoided, and number of negative fine needle aspirations/biopsies avoided. This study utilized de-identified data of RadPartners (RP) from 102 hospitals and 180 outpatient centers, 1936 CT scans pre-intervention and 2121 CT scans post-intervention were analyzed. Secondary analysis was performed utilizing Medicare cost data from a 5 percent sample data set from the Comparative Effectiveness and Data Analysis Resource (CEDAR). Results demonstrate a cost savings of $23,057,207 in the Medicare population with 7,592 negative fine needle aspirations/biopsies and 750 additional thyroid cancers detected. Using a clinical decision tree model and economic modeling, best practice development for the reporting of incidental thyroid nodules will lead to improvement in value of care. This model can be applied in future studies of other common incidentaloma management and associated Medicare cost analysis.


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