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

描述(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医疗护理，以便他们能够迅速恢复完整、富有成效的生活。然而，许多研究表明，美国的医疗质量并不理想。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非凡的价值。更好的护理可能会改善患者的功能状态，减少休假期间的工资损失。功能状况的改善还可能通过减少残疾抚恤金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、付款人和提供者似乎都承认，高质量的医疗保健可以产生价值--然而，很少有人(如果有的话)实施了监测或提高质量的计划。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，其他人可以从这些人那里学习质量改进的“为什么”和“方法”。在加利福尼亚州，一些主要的政策制定者、付款人和提供商组织准备采取行动-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，并为全国工人补偿环境中正在进行的质量评估和改进计划奠定基础。为了实现这些短期和长期目标，该项目有四个具体目标：(1)评估对与工作相关的CTS建议的护理程序的遵守情况，(2)检查遵守建议的护理程序与CTS患者结果之间的关系，(3)检查遵守建议的护理程序与CTS对工人和付款人的财务负担之间的关系，以及(4)向工人补偿利益攸关方和政策制定者传播结果。该项目将通过研究1200名患有CTS工人赔偿要求的患者来实现这些目标，这些患者正在接受北加州一个主要的工人赔偿提供者组织的治疗。质量将使用最近开发的兰德/加州大学洛杉矶分校CTS质量衡量标准进行评估。在提交索赔时和18个月后对患者进行的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赔偿金。与加州和其他州的工人补偿提供者组织、付款人和政策制定者建立的关系将促进这项工作的传播。拟议的研究与AHRQ的使命和目标直接相关，特别是：“医疗保健系统的能力……提供高质量、高价值的医疗保健；以及”为决策者提供评估系统变化对……质量……[和]成本的影响的能力。“

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..."