Quality of Care for Work-Associated Carpal Tunnel Syndrome

Abstract

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

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

“…Most subjects had medical risk factors for CTS (especially being overweight), constant symptoms, and low job satisfaction. Supporting Information Table 2 describes the study population …”

“…To evaluate quality of care, we reviewed electronic medical records. To assess outcomes, survey researchers interviewed subjects by telephone at baseline (August 2011–March 2013) and at follow‐up (May 2013–October 2014) …”

“…From this population, KPNC Regional Occupational Health identified adults aged 18 and above who had a diagnosis of CTS (International Classification of Diseases version 9 [ICD‐9] code 354.0 or 354.1) that was newly linked to a workers' compensation claim. We included patients who had atypical presentations, lacked electrodiagnostic confirmation, were eventually found not to have CTS, or were no longer covered under a workers' compensation claim because diagnostic uncertainty is common in CTS and, in our prior work, it was associated with receiving lower quality of care . Also, several quality measures addressed the diagnostic evaluation, and having a higher quality evaluation may be associated with more timely treatment and better outcomes.…”

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

“…In addition, there were modest disparities in quality of care by income. No significant disparities attributed to age, sex, or race/ethnicity were noted …”

“…No significant disparities attributed to age, sex, or race/ethnicity were noted. 18 3 | METHODS 19 The measures developed previously were refined for application to both non-occupational and occupational CTS. 20 Each measure was weighed against the six aims of healthcare improvement recommended by the National Academy of Medicine.…”