Carpal tunnel syndrome (CTS) commonly affects working-age adults, causes severe functional impairment, and leads to both medical and disability costs. Consequently, affected individuals must receive optimal medical care so that they can rapidly return to full, productive lives. Yet many studies have demonstrated that care in the U.S. is of suboptimal quality. For work-associated CTS, high quality medical care is likely to provide exceptional value to stakeholders within the healthcare system. Better care may improve patients'functional status and reduce wages lost during time off work. Improved functional status may also lower costs to employers by reducing disability payments and medical care costs. Workers'compensation policymakers, payors, and providers around the country appear to accept that quality care can produce value-yet few, if any, have implemented programs to monitor or improve quality. Deterrents include a lack of relevant quality measures, a misperception that limiting excessive use of medical care solves most quality problems, and a lack of early adopters from whom others can learn the "whys" and "hows" of quality improvement. In California, a few major policymakers, payors, and provider organizations are prepared to act-to become the early adopters from whom others can learn. This project seeks to measure quality of care for CTS, assess value to workers and payors, and lay the groundwork for ongoing quality assessment and improvement programs in workers'compensation settings nationally. To achieve these short and long-term objectives, this project has four specific aims: (1) to assess adherence to care processes recommended for work-associated CTS, (2) to examine the relationship between adherence to recommended care processes and outcomes for patients with CTS, (3) to examine the relationship between adherence to recommended care processes and the financial burden of CTS for workers'and payors, and (4) to disseminate findings to workers'compensation stakeholders and policymakers. This project will achieve these aims by studying 1,200 patients with workers'compensation claims for CTS who are treated by a major workers'compensation provider organization in Northern California. Quality will be assessed using the recently developed RAND/UCLA CTS Quality Measures. Surveys of patients at claim submission and 18 months later will provide information on symptoms, functional status, and lost wages. Costs to employers will be based on the costs of medical care plus disability payments. Established relationships with workers'compensation provider organizations, payors, and policymakers in California and other states will facilitate the dissemination of this work. The proposed research directly pertains to AHRQ's mission and goals, specifically: "the health care system's ability to...deliver high-quality, high-value healthcare;" and "provid [ing] policymakers with the ability to assess the impact of system changes on...quality...[and] cost..."

Public Health Relevance

Ensuring that patients with work-associated carpal tunnel syndrome receive high quality medical care may not only improve the patients'symptoms and ability to function, it may also save both the patients and their employer's money. This project will examine the quality of care provided to patients with CTS, determine how much quality influences patients'symptoms and ability to function, and examine how quality affects costs to patients (lost wages due to time off work) and their employers (medical care costs and disability payments).

National Institute of Health (NIH)
Agency for Healthcare Research and Quality (AHRQ)
Research Project (R01)
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Health Systems Research (HSR)
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Wittenberg, Kim
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Rand Corporation
Santa Monica
United States
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