Quality measures for the diagnosis and non-operative management of carpal tunnel syndrome in occupational settings.
Quality measures for the diagnosis and non-operative management of carpal tunnel syndrome in occupational settings.
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DOI：
10.1007/s10926-010-9260-6
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发表时间：
2011-03
影响因子：
3.3
通讯作者：
Asch, Steven
中科院分区：
文献类型：
--
作者：
Nuckols, Teryl;Harber, Philip;Sandin, Karl;Benner, Douglas;Weng, Haoling;Shaw, Rebecca;Griffin, Anne;Asch, Steven
简介：为患有职业相关性腕管综合征（CTS）的工人提供更高质量的医疗护理可能会减少残疾，促进重返工作岗位，并降低相关成本。虽然许多工人的赔偿制度已通过治疗准则，以减少过度使用不必要的护理，但对确保护理工作者确实得到高质量的关注有限。此外，指南的目的不是为了客观评估护理质量。本研究旨在为CTS的诊断评估和非手术管理制定质量措施，包括管理职业活动和功能限制。研究方法：我们使用公认的兰德/加州大学洛杉矶分校适当方法的变体，使用指南和文献综述制定了质量措施草案。接下来，在两轮改良德尔菲程序中，由11名美国CTS专家组成的多学科小组对这些措施的有效性和可行性进行了评估。结果：40项措施草案中，31项（78%）被专家评为有效和可行。9项措施涉及诊断评估，如评估症状、体征和风险因素。其中11种属于非手术治疗，如使用夹板、类固醇注射和药物治疗。其他11个解决评估症状和工作之间的关联，管理职业活动，并适应功能限制。结论：这些措施将补充现有的治疗指南，使供应商，付款人，政策制定者和研究人员能够以客观，结构化的方式评估CTS的护理质量。考虑到以前使用这些方法开发的措施的特征，更好地坚持这些措施可能会改善人群水平的患者结局。
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.
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影响因子：
4.7
作者：
Caliandro, P;La Torre, G;Padua, L
通讯作者：
Padua, L
影响因子：
9.9
作者：
Chang, MH;Chiang, HT;Lo, YK
通讯作者：
Lo, YK
影响因子：
39.2
作者：
Abásolo, L;Blanco, M;Jover, JA
通讯作者：
Jover, JA
DOI：
10.1097/01.jom.0000126029.07223.a0
发表时间：
2004-05-01
影响因子：
3.2
作者：
Amick, BC;Habeck, RV;Katz, JN
通讯作者：
Katz, JN
影响因子：
1.9
作者：
Atroshi, I;Johnsson, R;Ornstein, E
通讯作者：
Ornstein, E