Quality of electrodiagnostic testing for carpal tunnel syndrome: adherence to quality measures

Abstract

Introduction Research has shown that quality of health‐care services is often suboptimal. Little is known about the quality of electrodiagnostic testing. Methods We prospectively recruited 477 adults with workers' compensation claims for carpal tunnel syndrome (CTS) from 30 occupational health clinics and evaluated whether electrodiagnostic testing adhered to five process‐oriented quality measures. Results Among patients who had surgery for CTS, nearly all underwent recommended preoperative electrodiagnostic testing (measure #1, 170 of 174, 97.7%). Most electrodiagnostic tests included essential components (measure #2, 295 of 379, 77.8%). However, few reports documented skin temperature (measure #3, 93 of 379, 24.5%) and criteria were seldom met for interpreting test findings as consistent with CTS (measure #4, 41 of 284, 14.4%) or “severe” CTS (measure #5, 8 of 46, 17.4%). Discussion Most patients underwent testing before surgery, but test quality was often suboptimal. This work lays the groundwork for future efforts to monitor and improve the quality of electrodiagnostic testing for CTS.

The quality of electrodiagnostic tests for carpal tunnel syndrome: Implications for surgery, outcomes, and expenditures

“…Process‐oriented measures are tools for evaluating whether care adheres to recommended standards 12,13 . As described in an accompanying study, we found that, in a prospectively recruited population with workers’ compensation claims for CTS, electrodiagnostic test quality was variable 14 …”

“…12,13 As described in an accompanying study, we found that, in a prospectively recruited population with workers' compensation claims for CTS, electrodiagnostic test quality was variable. 14 Based on the same study population and four quality measures that address how electrodiagnostic tests are performed and interpreted, the present analysis had two objectives. First, we sought to quantify the degree to which accounting for test quality alters the appropriateness (ie, risk-benefit ratio) of surgery for CTS.…”

How can we get physicians to change their clinical behavior and embrace best practices?

“…The issues of what constitutes the essential components of a high‐quality EDx examination may be considered from many perspectives. We agree with the criteria used by Aragaki et al, 1 but we also recognize this is not without some controversy. Whichever criteria are adopted, the skill with which these are executed should be of concern as well.…”

“…In this issue of the Journal, Aragaki et al 1 Practice parameters have been published addressing both CTS diagnosis and treatment. [3][4][5][6][7][8] Despite these specific guidelines, several studies have demonstrated that only a minority of clinicians perform high-quality EDx studies for the evaluation of CTS.…”

“…[3][4][5][6][7][8] Despite these specific guidelines, several studies have demonstrated that only a minority of clinicians perform high-quality EDx studies for the evaluation of CTS. 1,9,10 It is not clear why more clinicians do not follow the recommendations for high-quality EDx studies. EDx medicine specialists are not alone in failing to adhere to clinically relevant, well-vetted, and readily available practice guidelines.…”