The quality of occupational healthcare for carpal tunnel syndrome, healthcare expenditures, and disability outcomes: A prospective observational study.
The quality of occupational healthcare for carpal tunnel syndrome, healthcare expenditures, and disability outcomes: A prospective observational study.
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DOI：
10.1002/mus.27718
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发表时间：
2023-01
期刊：
影响因子：
3.4
通讯作者：
Asch, Steven M.
中科院分区：
文献类型：
--
作者：
Nuckols, Teryl K.;Dworsky, Michael;Conlon, Craig;Robbins, Michael;Benner, Douglas;Seabury, Seth;Asch, Steven M.
在以前的工作中，工作相关腕管综合征（CTS）的高质量护理与症状改善，功能状态和整体健康相关。我们试图研究护理质量是否与医疗支出或残疾有关。在343名患有CTS工人赔偿索赔的成年人中，我们为未充分使用（未获得高度有益的护理）和过度使用（接受风险超过收益的护理）创建了患者水平的综合质量评分。我们评估了每个综合质量评分（0%-100%，100% =更好的护理）是否与医疗保健支出（18个月支出，任何预期的未来支出需求）或残疾（暂时残疾的天数，18个月时的永久性损伤评级）相关。使用不足的平均总体质量评分为77.8%（标准差[SD] 16.5%），过度使用的平均总体质量评分为89.2%（SD 11.0%）。相对于0%的评分，100%的未充分使用评分与较高的风险调整后18个月支出相关（3672美元; 95%置信区间[CI] 324至7021美元），但与未来支出无关（-0.07个百分点; 95% CI-0.48至0.34）。过度使用评分为100%与较低的18个月支出（− 4549美元，95% CI − 8792至− 306美元）和未来支出的可能性略低（−0.62个百分点，95% CI −1.23至−0.02）相关。护理质量与残疾无关。提高医疗质量可能会增加或降低短期医疗支出，这取决于目前医疗服务使用不足或过度使用的频率。未来的研究需要在不同的工人的补偿背景下的护理质量，以及有效和经济的战略，以提高质量。更高质量的CTS职业保健与改善症状，功能和健康有关。这项研究评估了343名成年人的质量是否也与医疗费用或18个月以上的残疾有关。坚持过度使用措施与较低的成本有关（高达-4549美元）。坚持使用不足的措施与更高的成本（高达3672美元）。质量与残疾无关。提高质量可能会增加或降低成本，这取决于基线使用不足和过度使用。
In prior work, higher quality care for work‐associated carpal tunnel syndrome (CTS) was associated with improved symptoms, functional status, and overall health. We sought to examine whether quality of care is associated with healthcare expenditures or disability. Among 343 adults with workers' compensation claims for CTS, we created patient‐level aggregate quality scores for underuse (not receiving highly beneficial care) and overuse (receiving care for which risks exceed benefits). We assessed whether each aggregate quality score (0%–100%, 100% = better care) was associated with healthcare expenditures (18‐mo expenditures, any anticipated need for future expenditures) or disability (days on temporary disability, permanent impairment rating at 18 mo). Mean aggregate quality scores were 77.8% (standard deviation [SD] 16.5%) for underuse and 89.2% (SD 11.0%) for overuse. An underuse score of 100% was associated with higher risk‐adjusted 18‐mo expenditures ($3672; 95% confidence interval [CI] $324 to $7021) but not with future expenditures (−0.07 percentage points; 95% CI −0.48 to 0.34), relative to a score of 0%. An overuse score of 100% was associated with lower 18‐mo expenditures (−$4549, 95% CI −$8792 to −$306) and a modestly lower likelihood of future expenditures (−0.62 percentage points, 95% CI −1.23 to −0.02). Quality of care was not associated with disability. Improving quality of care could increase or lower short‐term healthcare expenditures, depending on how often care is currently underused or overused. Future research is needed on quality of care in varied workers' compensation contexts, as well as effective and economical strategies for improving quality. Higher quality occupational healthcare for CTS is associated with improved symptoms, function, and health. This study assessed whether quality was also associated with healthcare costs or disability over 18 mo among 343 adults. Adherence to overuse measures was associated with lower costs (up to −$4549). Adherence to underuse measures was associated with higher costs (up to $3672). Quality was not associated with disability. Improving quality could increase or lower costs, depending on baseline underuse and overuse.
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DOI：
10.1097/jom.0000000000000916
发表时间：
2017-01-01
影响因子：
3.2
作者：
Nuckols, Teryl;Conlon, Craig;Asch, Steven M.
通讯作者：
Asch, Steven M.
影响因子：
3.4
作者：
Nuckols, Teryl K.;Conlon, Craig;Asch, Steven M.
通讯作者：
Asch, Steven M.
影响因子：
3.4
作者：
Aragaki，Dixie;Basu，Aashna;Nuckols，Teryl K.
通讯作者：
Nuckols，Teryl K.
影响因子：
39.2
作者：
Abásolo, L;Blanco, M;Jover, JA
通讯作者：
Jover, JA
影响因子：
3.5
作者：
Daniell, William E.;Fulton-Kehoe, Deborah;Franklin, Gary M.
通讯作者：
Franklin, Gary M.