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

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，美国的护理质量不佳。对于与工作相关的CTS，高质量的医疗护理可能会为医疗保健系统内的利益相关者提供卓越的价值。更好的护理可以改善病人的功能状态，减少下班时的工资损失。改善功能状况还可以通过减少残疾津贴和医疗保健费用来降低雇主的成本。 全国各地的工人赔偿政策制定者、支付者和提供者似乎都接受高质量的医疗服务可以产生价值，但很少有人（如果有的话）实施监督或提高质量的计划。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服务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学习质量改进的“为什么”和“如何”。在加州，一些主要的政策制定者、支付者和提供者组织准备采取行动，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，并为全国工人赔偿环境中正在进行的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，该项目有四个具体目标：（1）评估对工作相关CTS推荐的护理过程的依从性，（2）检查对CTS患者的推荐护理过程的依从性和结果之间的关系，（3）检查对推荐护理过程的依从性和CTS对工人和支付者的经济负担之间的关系，以及（4）向工人赔偿利益相关者和政策制定者传播调查结果。 该项目将通过研究北方加州一家主要的工人赔偿提供者组织治疗的1,200名CTS工人赔偿索赔患者来实现这些目标。将使用最近制定的兰德/UCLA CTS质量措施评估质量。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。雇主的费用将基于医疗费用加上残疾津贴。与加州和其他州的工人赔偿提供者组织、付款人和决策者建立的关系将促进这项工作的传播。 拟议的研究直接涉及AHRQ的使命和目标，特别是：“卫生保健系统的能力，.提供高质量、高价值的医疗保健;”以及“为政策制定者提供评估系统变化对……的影响的能力。质量... [and]成本... " 公共卫生相关性：确保与工作相关的腕管综合征患者接受高质量的医疗护理不仅可以改善患者的症状和功能，还可以节省患者和雇主的资金。该项目将检查为CTS患者提供的护理质量，确定质量对患者症状和功能的影响程度，并检查质量如何影响患者的成本（因休假而损失的工资）及其雇主（医疗费用和残疾付款）。

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..." PUBLIC HEALTH RELEVANCE: Ensuring that patients with work-associated carpal tunnel syndrome receive high quality medical care may not only improve the patients' symptoms and ability to function, it may also save both the patients and their employer's money. This project will examine the quality of care provided to patients with CTS, determine how much quality influences patients' symptoms and ability to function, and examine how quality affects costs to patients (lost wages due to time off work) and their employers (medical care costs and disability payments).