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Efforts should be made to ensure that patients with CTS receive essential care processes including necessary surgery and activity assessment and management. Muscle Nerve 57: 896-904, 2018.

Objective-To evaluate the quality of care provided to individuals with workers' compensation claims related to CTS and identify patient characteristics associated with receiving better care.Methods-We recruited subjects with new claims for CTS from 30 occupational clinics affiliated with Kaiser Permanente Northern California. We applied 45 process-oriented quality measures to 477 subjects' medical records, and performed multivariate logistic regression to identify patient characteristics associated with quality. Craig Conlon served as site principal investigator, overseeing data collection and providing input on issues related to care for CTS and workers' compensation. Michael Robbins oversaw statistical analyses. Michael Dworsky provided input on issues related to workers' compensation and assisted with data analysis and interpretation. Julie Lai and Rachana performed statistical analyses. Carol P. Roth assisted with the design of and oversaw the completion of the medical record reviews. Seth Seabury and John Adams contributed to study design, analytical methods, and interpretation of results. Barbara Levitan assisted with the design of and oversaw the completion of the surveys. Author Access to Data: All authors had access to study data. Payment for the Work: All authors received payment for the work, except John Adams, who donated his time. Results Potential Conflicts of Interest:The authors have no other potential conflicts of interest to report. Conclusions-Care processes for work-associated CTS frequently adhered to quality measures. Clinical factors were more strongly associated with quality than demographic and socioeconomic ones. HHS Public Access

Medicaid expansions did not change all-payer admission volumes, but they were associated with increased Medicaid and decreased uninsured volumes. Results suggest those previously uninsured with greater needs for inpatient services were most likely to gain coverage. Compositional changes in uninsured and Medicaid admissions may be due to selection.

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The timing of diagnosis varied, but time off work was generally short and related to surgery. If associations of quality of care with key medical, economic, and quality-of-life outcomes are identified for work-associated CTS, systematic efforts to evaluate and improve quality of medical care for this condition are warranted.

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Workers' compensation is a state-level social insurance program that provides financial, medical, and rehabilitation benefits to workers who sustain job-related injuries or illnesses. Workers, employers, and other stakeholders involved in workers' compensation systems have long voiced concerns about the extent to which workers' compensation promotes occupational safety and health (OSH) and the well-being of injured workers; government reports and journalistic accounts in recent years have both highlighted perennial issues and documented emerging concerns. Key topic areas highlighted in these accounts include prevention of injury and disability; system coverage, benefit adequacy, and cost spillovers; claim management processes; and occupational health care. Despite the awareness of these issues across stakeholder groups, it is not clear how much consensus there is about which of these challenges to OSH in the workers' compensation system are most pressing, whether there is sufficient evidence to identify best practices, or what structural barriers have prevented policymakers from resolving these challenges.The National Institute for Occupational Safety and Health (NIOSH) requested that RAND explore the beliefs and priorities of key workers' compensation stakeholder groups about system challenges and research priorities that, if addressed, would be most useful for reforming workers' compensation systems to promote OSH and the well-being of workers. RAND conducted a literature scan to identify published criticisms of current workers' compensation systems, focusing on the implications of workers' compensation for worker safety, health, and economic well-being. After producing a compendium of such perspectives, RAND then convened a series of stakeholder conversations with selected representatives from five stakeholder groups. This report describes stakeholder views and attempts to synthesize these perspectives to offer suggestions for research and policy-analysis priorities likely to make workers' compensation policy more effective at promoting the health and well-being of workers.The research reported here was conducted in the RAND Justice Policy Program, which spans both criminal and civil justice system issues with such topics as public safety, effective policing, police-community relations, drug policy and enforcement, corrections policy, use of technology in law enforcement, tort reform, catastrophe and mass-injury compensation, court resourcing, and insurance regulation. Program research is supported by government agencies, foundations, and the private sector.RAND Justice, Infrastructure, and Environment (JIE) conducts research and analysis in civil and criminal justice, infrastructure development and financing, environmental policy, transportation planning and technology, immigration and border protection, public and occupational safety, energy policy, science and innovation policy, space, telecommunications, and trends and implications of artificial intelligence and other computational technologies. iv Questio...