Quality of care and patient‐reported outcomes in carpal tunnel syndrome: A prospective observational study

Abstract

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.

Quality measures: Do they measure up?

“…Nuckols et al . demonstrate that better care on aggregate underuse measures (80th percentile of adherence) resulted in greater patient‐reported improvements in BCTQ symptom severity (BCTQ‐ss), BCTQ functional status (BCTQ‐fs), and SF‐12 physical function . Interestingly, avoiding overuse was associated with less improvement, but this was not significant.…”

“…The study by Nuckols and colleagues in this issue of the Journal is a prospective, observational study that attempts to evaluate whether following recommended care processes changes patient‐reported outcomes in occupational CTS. The quality measures evaluated in their study were developed in 2011 by the RAND corporation using the RAND/UCLA appropriateness method .…”

“…Outcomes were measured by telephone interviews of participants at baseline and at 18 months. The authors derived aggregate underuse and overuse scores based on 45 quality measures . Quality deficits have been defined as underuse, overuse, and misuse by the NAM, and this study is an interesting application of that definition .…”

“…In participants for whom surgery was deemed appropriate or of uncertain appropriateness, undergoing surgery was associated with improvement in BTCQ‐ss, and, for the latter group, in BTCQ‐fs as well. Outcomes after inappropriate surgery could not be assessed as the number of such surgeries was low . These data, if available, may have provided insights regarding the contribution of the placebo effect of surgery to the results, especially since the outcome measures are patient reported.…”

Quality measures in electrodiagnosis: Carpal tunnel syndrome—An AANEM Quality Measure Set

“…In a prospective observational study of adults with a diagnosis of CTS, physician adherence to recommended care processes (80th vs 20th percentile for adherence) was associated with greater improvements in symptom severity, functional status, and overall quality of life. Symptom improvement occurred when physicians assessed and managed activity, patients underwent necessary surgery, and employers adjusted job tasks …”