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
AU - Sandin, Karl
AU - Benner, Douglas
AU - Weng, Haoling
AU - Shaw, Rebecca
AU - Griffin, Anne
AU - Asch, Steven
N1 - Funding Information:
Grants This project was jointly supported through a contract with the California Commission on Health and Safety and Workers’ Compensation (CHSWC) and a project-directed gift from Zenith Insurance. CHSWC is a State-sponsored joint labor-management body charged with overseeing the health and safety and workers’ compensation systems in California and recommending administrative or legislative modifications to improve their operation. Zenith Insurance is a workers’ compensation insurance company based in Woodland Hills, California. The RAND/UCLA team was wholly responsible for the design and execution of this study, including the development of draft measures, selecting panelists, convening the panel, analyzing results, and preparing manuscripts for journal submission. The funding sources played no role in these activities. We instituted several precautions to prevent the source of funding from influencing the research: (1) the work was conceived of and developed by the researchers well before Zenith Insurance provided funding, (2) a minority of the funding came from Zenith Insurance, (3) Zenith Insurance provided the funding as a gift without condition, (4) neither funder played any role in the development and selection of the draft measures, (5) neither played any role in the expert panel’s analysis of the measures or the researchers’ analysis of the panelists’ ratings, and (6) neither played any role in the interpretation of results or drafting of the manuscript (indeed, they never even provided comments on it).
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
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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 -