Carpal Tunnel Syndrome as a Test Case for Value Assessment During the Presurgical Period: The Impact of Structure and Processes of Care.
Carpal Tunnel Syndrome as a Test Case for Value Assessment During the Presurgical Period: The Impact of Structure and Processes of Care.
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腕管综合症作为术前价值评估的测试用例：护理结构和过程的影响。
DOI：
10.1097/mlr.0000000000001790
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发表时间：
2023
期刊：
影响因子：
3
通讯作者：
Kerr,EveA
中科院分区：
文献类型：
--
作者：
Sears,ErikaD;Evans,Richard;Burns,Jennifer;Chung,KevinC;Hayward,RodneyA;Kerr,EveA
研究设计：利用退伍军人事务部(VA)的国家管理数据进行了一项回溯性的队列研究。研究对象：那些在退伍军人事务部(VA)初级保健诊所至少接受过一次CTS评估，并在7年内接受腕管松解的患者。测量：我们根据两个结果来模拟设施水平的性能：CTS的手术延迟(质量标志)和术前遭遇次数(利用)，结果：在127个VA医疗中心的41,912名接受腕管松解的退伍军人中，设施水平预测的手术延迟概率中位数为48%，其中16个(13%)设施水平的延迟显著低于中位数，13个设施(10%)的设施延迟较大。设施水平的中位数预测手术前相遇次数为8.8次，其中22家(17%)机构的相遇次数明显较少，22家(17%)机构的相遇次数较多。与模型中包含的结构性变量相比，护理过程与这两种结果的关联性更强。与预测延迟和利用率偏差最大的过程包括接受重复电诊断测试，使用2个或更多非手术治疗，以及VA以外的社区转诊。结论：以CTS为测试案例，本研究证明了评估术前价值和确定与术前延迟和利用绩效相关的可修改护理过程的潜力。
Background:Few performance measures assess presurgical value (quality and utilization).Objectives:Using carpal tunnel syndrome (CTS) as a case study:(1) develop a model to evaluate presurgical quality and utilization and (2) identify opportunities for value improvement.Research Design:A retrospective cohort study utilizing Veterans Affairs (VA) national administrative data.Subjects:Patients who were evaluated in a VA primary care clinic on at least 1 occasion for CTS and received carpal tunnel release over a 7-year period.Measures:We modeled facility-level performance on 2 outcomes: surgical delay (marker of quality) and number of presurgical encounters (utilization) for CTS, and examined association between patient, facility, and care process variables and performance.Results:Among 41,912 Veterans undergoing carpal tunnel release at 127 VA medical centers, the median facility-level predicted probability of surgical delay was 48%, with 16 (13%) facilities having significantly less delay than the median and 13 (10%) facilities having greater delay. The median facility-level predicted number of presurgical encounters was 8.8 visits, with 22 (17%) facilities having significantly fewer encounters and 22 (17%) facilities having more. Care processes had a stronger association with both outcomes than structural variables included in the models. Processes associated with the greatest deviations in predicted delay and utilization included receipt of repeat electrodiagnostic testing, use of 2 or more nonoperative treatments, and community referral outside of VA.Conclusions:Using CTS as a test case, this study demonstrates the potential to assess presurgical value and identify modifiable care processes associated with presurgical delay and utilization performance.