Abstract
Introduction: Providing higher quality medical care to workers with occupationally associated carpal tunnel syndrome (CTS) may reduce disability, facilitate return to work, and lower the associated costs. Although many workers' compensation systems have adopted treatment guidelines to reduce the overuse of unnecessary care, limited attention has been paid to ensuring that the care workers do receive is high quality. Further, guidelines are not designed to enable objective assessments of quality of care. This study sought to develop quality measures for the diagnostic evaluation and non-operative management of CTS, including managing occupational activities and functional limitations. Methods: Using a variation of the well-established RAND/UCLA Appropriateness Method, we developed draft quality measures using guidelines and literature reviews. Next, in a two-round modified-Delphi process, a multidisciplinary panel of 11 U.S. experts in CTS rated the measures on validity and feasibility. Results: Of 40 draft measures, experts rated 31 (78%) valid and feasible. Nine measures pertained to diagnostic evaluation, such as assessing symptoms, signs, and risk factors. Eleven pertain to non-operative treatments, such as the use of splints, steroid injections, and medications. Eleven others address assessing the association between symptoms and work, managing occupational activities, and accommodating functional limitations. Conclusions: These measures will complement existing treatment guidelines by enabling providers, payers, policymakers, and researchers to assess quality of care for CTS in an objective, structured manner. Given the characteristics of previous measures developed with these methods, greater adherence to these measures will probably lead to improved patient outcomes at a population level.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 100-119 |
| Number of pages | 20 |
| Journal | Journal of Occupational Rehabilitation |
| Volume | 21 |
| Issue number | 1 |
| DOIs | |
| State | Published - Mar 2011 |
| Externally published | Yes |
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Keywords
- Carpal tunnel syndrome
- Health care quality assurance
- Standards
ASJC Scopus subject areas
- Rehabilitation
- Occupational Therapy
Cite this
Quality measures for the diagnosis and non-operative management of carpal tunnel syndrome in occupational settings. / Nuckols, Teryl; Harber, Philip I; Sandin, Karl; Benner, Douglas; Weng, Haoling; Shaw, Rebecca; Griffin, Anne; Asch, Steven.
In: Journal of Occupational Rehabilitation, Vol. 21, No. 1, 03.2011, p. 100-119.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Quality measures for the diagnosis and non-operative management of carpal tunnel syndrome in occupational settings
AU - Nuckols, Teryl
AU - Harber, Philip I
AU - Sandin, Karl
AU - Benner, Douglas
AU - Weng, Haoling
AU - Shaw, Rebecca
AU - Griffin, Anne
AU - Asch, Steven
PY - 2011/3
Y1 - 2011/3
N2 - Introduction: Providing higher quality medical care to workers with occupationally associated carpal tunnel syndrome (CTS) may reduce disability, facilitate return to work, and lower the associated costs. Although many workers' compensation systems have adopted treatment guidelines to reduce the overuse of unnecessary care, limited attention has been paid to ensuring that the care workers do receive is high quality. Further, guidelines are not designed to enable objective assessments of quality of care. This study sought to develop quality measures for the diagnostic evaluation and non-operative management of CTS, including managing occupational activities and functional limitations. Methods: Using a variation of the well-established RAND/UCLA Appropriateness Method, we developed draft quality measures using guidelines and literature reviews. Next, in a two-round modified-Delphi process, a multidisciplinary panel of 11 U.S. experts in CTS rated the measures on validity and feasibility. Results: Of 40 draft measures, experts rated 31 (78%) valid and feasible. Nine measures pertained to diagnostic evaluation, such as assessing symptoms, signs, and risk factors. Eleven pertain to non-operative treatments, such as the use of splints, steroid injections, and medications. Eleven others address assessing the association between symptoms and work, managing occupational activities, and accommodating functional limitations. Conclusions: These measures will complement existing treatment guidelines by enabling providers, payers, policymakers, and researchers to assess quality of care for CTS in an objective, structured manner. Given the characteristics of previous measures developed with these methods, greater adherence to these measures will probably lead to improved patient outcomes at a population level.
AB - Introduction: Providing higher quality medical care to workers with occupationally associated carpal tunnel syndrome (CTS) may reduce disability, facilitate return to work, and lower the associated costs. Although many workers' compensation systems have adopted treatment guidelines to reduce the overuse of unnecessary care, limited attention has been paid to ensuring that the care workers do receive is high quality. Further, guidelines are not designed to enable objective assessments of quality of care. This study sought to develop quality measures for the diagnostic evaluation and non-operative management of CTS, including managing occupational activities and functional limitations. Methods: Using a variation of the well-established RAND/UCLA Appropriateness Method, we developed draft quality measures using guidelines and literature reviews. Next, in a two-round modified-Delphi process, a multidisciplinary panel of 11 U.S. experts in CTS rated the measures on validity and feasibility. Results: Of 40 draft measures, experts rated 31 (78%) valid and feasible. Nine measures pertained to diagnostic evaluation, such as assessing symptoms, signs, and risk factors. Eleven pertain to non-operative treatments, such as the use of splints, steroid injections, and medications. Eleven others address assessing the association between symptoms and work, managing occupational activities, and accommodating functional limitations. Conclusions: These measures will complement existing treatment guidelines by enabling providers, payers, policymakers, and researchers to assess quality of care for CTS in an objective, structured manner. Given the characteristics of previous measures developed with these methods, greater adherence to these measures will probably lead to improved patient outcomes at a population level.
KW - Carpal tunnel syndrome
KW - Health care quality assurance
KW - Standards
UR - http://www.scopus.com/inward/record.url?scp=79952194904&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=79952194904&partnerID=8YFLogxK
U2 - 10.1007/s10926-010-9260-6
DO - 10.1007/s10926-010-9260-6
M3 - Article
C2 - 20737200
AN - SCOPUS:79952194904
VL - 21
SP - 100
EP - 119
JO - Journal of Occupational Rehabilitation
JF - Journal of Occupational Rehabilitation
SN - 1053-0487
IS - 1
ER -