Assessing the Value of High-Quality Care for Work-Associated Carpal Tunnel Syndrome in a Large Integrated Health Care System: Study Design.
Assessing the Value of High-Quality Care for Work-Associated Carpal Tunnel Syndrome in a Large Integrated Health Care System: Study Design.
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DOI：
10.7812/tpp/15-220
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发表时间：
2016-01-01
影响因子：
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通讯作者：
Nuckols, Teryl
中科院分区：
文献类型：
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作者：
Conlon, Craig;Asch, Steven;Nuckols, Teryl
背景：对职业健康障碍的护理质量知之甚少，尽管它可能影响工人的健康和工人的赔偿费用。腕管综合征（CTS）是一种常见的与工作相关的疾病，可导致严重的残疾。目的：描述一项研究的设计，该研究旨在评估与工作相关的CTS的护理质量及其与临床结果和成本的关系。设计：前瞻性观察研究纳入2011 - 2013年在30家职业健康诊所接受治疗的477名无急性创伤CTS新工伤赔偿索赔患者，随访18个月。主要结局指标：关键临床事件的时间、对45项质量指标的依从性、波士顿腕管调查问卷和12项简短健康调查版本2 （SF-12v2）得分的变化，以及与医疗和残疾相关的成本。结果：267名受试者（56%）在第一次职业健康就诊前后被诊断为CTS并提出索赔，104名受试者（22%）在第一次职业健康就诊前得到诊断并提出索赔，98名受试者（21%）在第一次职业健康就诊后得到诊断或提出索赔。178名（37%）受试者有休假，其中147例（83%）患者在手术前后开始休假，中位数持续41天（四分位数差= 42天）。结论：诊断时间各不相同，但休假时间普遍较短，且与手术有关。如果确定了与工作相关的CTS的护理质量与关键的医疗、经济和生活质量结果的关联，则有必要系统地评估和提高这种疾病的医疗质量。
CONTEXT: Little is known about quality of care for occupational health disorders, although it may affect worker health and workers' compensation costs. Carpal tunnel syndrome (CTS) is a common work-associated condition that causes substantial disability.OBJECTIVE: To describe the design of a study that is assessing quality of care for work-associated CTS and associations with clinical outcomes and costs.DESIGN: Prospective observational study of 477 individuals with new workers' compensation claims for CTS without acute trauma who were treated at 30 occupational health clinics from 2011 to 2013 and followed for 18 months.MAIN OUTCOME MEASURES: Timing of key clinical events, adherence to 45 quality measures, changes in scores on the Boston Carpal Tunnel Questionnaire and 12-item Short Form Health Survey Version 2 (SF-12v2), and costs associated with medical care and disability.RESULTS: Two hundred sixty-seven subjects (56%) received a diagnosis of CTS and had claims filed around the first visit to occupational health, 104 (22%) received a diagnosis before that visit and claim, and 98 (21%) received a diagnosis or had claims filed after that visit. One hundred seventy-eight (37%) subjects had time off work, which started around the time of surgery in 147 (83%) cases and lasted a median of 41 days (interquartile range = 42 days).CONCLUSIONS: The timing of diagnosis varied, but time off work was generally short and related to surgery. If associations of quality of care with key medical, economic, and quality-of-life outcomes are identified for work-associated CTS, systematic efforts to evaluate and improve quality of medical care for this condition are warranted.