The Value of High Quality Medical Care for Work-Associated Carpal Tunnel Syndrome

高质量医疗护理对工作相关腕管综合症的价值

• 批准号: 8708807
• 负责人: Teryl Nuckols
• 金额: $ 49.58万
• 依托单位: RAND CORPORATION
• 依托单位国家: 美国
• 财政年份: 2010
• 资助国家: 美国
• 起止时间: 2010-09-30 至 2016-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8708807
• 关键词: Value; Quality; Medical; Care; Work

DESCRIPTION (provided by applicant): 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..."

描述（由申请人提供）：腕管综合征（CTS）通常影响工作年龄的成年人，导致严重的功能障碍，并导致医疗和残疾费用。因此，受影响的个人必须得到最佳的医疗护理，以便他们能够迅速恢复充实、有生产力的生活。然而，许多研究表明，美国的医疗服务质量并不理想。对于与工作相关的CTS，高质量的医疗保健可能会为医疗保健系统中的利益相关者提供特殊的价值。更好的护理可以改善病人的功能状态，减少下班期间的工资损失。功能状况的改善还可以通过减少残疾津贴和医疗费用来降低雇主的成本。全国各地的工人补偿政策制定者、支付者和提供者似乎都接受高质量的护理可以产生价值——然而，很少有人（如果有的话）实施了监控或提高质量的计划。阻碍因素包括缺乏相关的质量措施，错误地认为限制过度使用医疗保健可以解决大多数质量问题，以及缺乏早期采用者，其他人可以从他们那里了解质量改进的“原因”和“方法”。在加州，一些主要的政策制定者、支付方和提供方组织已经准备好采取行动——成为其他人可以学习的早期采用者。该项目旨在衡量CTS的护理质量，评估对工人和付款人的价值，并为全国工人补偿设置的持续质量评估和改进方案奠定基础。为了实现这些短期和长期目标，本项目有四个具体目标：(1)评估对工作相关CTS推荐护理流程的依从性，(2)检查CTS患者对推荐护理流程的依从性与结果之间的关系，(3)检查对推荐护理流程的依从性与CTS工人和付款人的经济负担之间的关系，以及(4)将研究结果传播给工人补偿利益相关者和决策者。该项目将通过研究1,200名要求工人赔偿的CTS患者来实现这些目标，这些患者由北加州一家主要的工人赔偿提供机构治疗。质量将使用最近开发的兰德/加州大学洛杉矶分校CTS质量措施进行评估。在提交索赔时和18个月后对患者进行调查，将提供有关症状、功能状态和工资损失的信息。雇主支付的费用将基于医疗费用加上残疾补助。与加利福尼亚州和其他州的工人赔偿提供机构、付款人和政策制定者建立的关系将促进这项工作的传播。拟议的研究直接关系到AHRQ的使命和目标，具体来说：“医疗保健系统……提供高质量、高价值医疗保健的能力；”以及“为决策者提供评估系统变化对……质量……影响的能力……”[和]成本……”

项目成果

Quality measures for the diagnosis and non-operative management of carpal tunnel syndrome in occupational settings.

• DOI: 10.1007/s10926-010-9260-6
• 发表时间: 2011-03
• 期刊: JOURNAL OF OCCUPATIONAL REHABILITATION
• 影响因子: 3.3
• 作者: Nuckols, Teryl;Harber, Philip;Sandin, Karl;Benner, Douglas;Weng, Haoling;Shaw, Rebecca;Griffin, Anne;Asch, Steven
• 通讯作者: Asch, Steven

Clinical quality measures for intraoperative and perioperative management in carpal tunnel surgery.

• DOI: 10.1007/s11552-011-9325-9
• 发表时间: 2011-06
• 期刊: Hand (New York, N.Y.)
• 作者: Nuckols, Teryl K;Maggard Gibbons, Melinda;Harness, Neil G;Chang, Walter T;Chung, Kevin C;Asch, Steven M
• 通讯作者: Asch, Steven M

Assessing the Value of High-Quality Care for Work-Associated Carpal Tunnel Syndrome in a Large Integrated Health Care System: Study Design.

• DOI: 10.7812/tpp/15-220
• 发表时间: 2016-01-01
• 期刊: The Permanente journal
• 作者: Conlon, Craig;Asch, Steven;Nuckols, Teryl
• 通讯作者: Nuckols, Teryl

The quality of occupational healthcare for carpal tunnel syndrome, healthcare expenditures, and disability outcomes: A prospective observational study.

• DOI: 10.1002/mus.27718
• 发表时间: 2023-01
• 期刊: MUSCLE & NERVE
• 影响因子: 3.4
• 作者: Nuckols, Teryl K.;Dworsky, Michael;Conlon, Craig;Robbins, Michael;Benner, Douglas;Seabury, Seth;Asch, Steven M.
• 通讯作者: Asch, Steven M.