Quality measures for the diagnosis and non-operative management of carpal tunnel syndrome in occupational settings.
BACKGROUND
Providing higher quality medical care to workers with occupationally associated carpal tunnel syndrome (CTS) may reduce disability, facilitate return to work, and lower the associated costs. Although many workers' compensation systems have adopted treatment guidelines to reduce the overuse of unnecessary care, limited attention has been paid to ensuring that the care workers do receive is high quality. Further, guidelines are not designed to enable objective assessments of quality of care. This study sought to develop quality measures for the diagnostic evaluation and non-operative management of CTS, including managing occupational activities and functional limitations.


METHODS
Using a variation of the well-established RAND/UCLA Appropriateness Method, we developed draft quality measures using guidelines and literature reviews. Next, in a two-round modified-Delphi process, a multidisciplinary panel of 11 U.S. experts in CTS rated the measures on validity and feasibility.


RESULTS
Of 40 draft measures, experts rated 31 (78%) valid and feasible. Nine measures pertained to diagnostic evaluation, such as assessing symptoms, signs, and risk factors. Eleven pertain to non-operative treatments, such as the use of splints, steroid injections, and medications. Eleven others address assessing the association between symptoms and work, managing occupational activities, and accommodating functional limitations.


CONCLUSIONS
These measures will complement existing treatment guidelines by enabling providers, payers, policymakers, and researchers to assess quality of care for CTS in an objective, structured manner. Given the characteristics of previous measures developed with these methods, greater adherence to these measures will probably lead to improved patient outcomes at a population level.
Nuckols
Teryl
T
Health Services Researcher, RAND Corporation, 1776 Main St, PO Box 2138, Santa Monica, CA 90407-2138, USA. tnuckols@mednet.ucla.edu
Harber
Philip
P
Sandin
Karl
K
Benner
Douglas
D
Weng
Haoling
H
Shaw
Rebecca
R
Griffin
Anne
A
Asch
Steven
S
D002349:Carpal Tunnel Syndrome / Q000175:diagnosis* / Q000628:therapy*; D003695:Delivery of Health Care / Q000458:organization & administration; D004185:Disability Evaluation; D006801:Humans; D009784:Occupational Diseases / Q000175:diagnosis / Q000628:therapy; D009787:Occupational Medicine / Q000592:standards*; D017410:Practice Guidelines as Topic / Q000592:standards*; D011367:Professional Staff Committees; D019984:Quality Indicators, Health Care; D015203:Reproducibility of Results