Adverse Cascade Effects (ACE) – Undesirable cascade effects. Trigger and progress of clinical treatment pathways in patients with thyroid anomalies.
Cascades are defined as “processes that, once initiated, will stepwise proceed until their seemingly inevitable results”. One common example is the treatment of patients with thyroid nodules being potentially malignant. To die from thyroid cancer remains rare due to the underlying pathology of this type of cancer. However, the detection and thus prevalence of thyroid cancer has rapidly increased over the last few decades without an increase in patient mortality. This implies the phenomenon of over-diagnosis. As a result, a growing amount of thyroid surgery is carried out on benign nodules that would not have needed to be removed. We claim that the diagnosis of thyroid nodules through routine ultrasound imaging is often the trigger for cascade effects leading to unnecessary follow-up over many years or to invasive treatment.
Aim
There are no systematic analyses of the frequency, driving forces and effects of this kinds of cascades. Our project aimed to fill this gap by analyzing both routine data from General Practice and looking at clinical pathways of patients with thyroid anomalies.
Partners
This project was implemented by the Institute of General Practice in close cooperation with the Departmen of Health Management, the Interdisciplinary Centre of Public Health and the Institute for Medical Computing, Biometry and Epidemiology.
Health insurance data was provided by the Bavarian Association of Statutory Health Insurance Physicians (KVB) and the GWQ Service Plus AG.