title: Assessing the Value of High-Quality Care for Work-Associated Carpal Tunnel Syndrome in a Large Integrated Health Care System: Study Design.
abstract: Little is known about quality of care for occupational health disorders, although it may affect worker health and workers' compensation costs. Carpal tunnel syndrome (CTS) is a common work-associated condition that causes substantial disability.
  
  
  
  To describe the design of a study that is assessing quality of care for work-associated CTS and associations with clinical outcomes and costs.
  
  
  
  Prospective observational study of 477 individuals with new workers' compensation claims for CTS without acute trauma who were treated at 30 occupational health clinics from 2011 to 2013 and followed for 18 months.
  
  
  
  Timing of key clinical events, adherence to 45 quality measures, changes in scores on the Boston Carpal Tunnel Questionnaire and 12-item Short Form Health Survey Version 2 (SF-12v2), and costs associated with medical care and disability.
  
  
  
  Two hundred sixty-seven subjects (56%) received a diagnosis of CTS and had claims filed around the first visit to occupational health, 104 (22%) received a diagnosis before that visit and claim, and 98 (21%) received a diagnosis or had claims filed after that visit. One hundred seventy-eight (37%) subjects had time off work, which started around the time of surgery in 147 (83%) cases and lasted a median of 41 days (interquartile range = 42 days).
  
  
  
  The timing of diagnosis varied, but time off work was generally short and related to surgery. If associations of quality of care with key medical, economic, and quality-of-life outcomes are identified for work-associated CTS, systematic efforts to evaluate and improve quality of medical care for this condition are warranted.
authors.affiliation: Medical Director of Employee Health Services for Kaiser Permanente in Oakland, CA. craig.x.conlon@kp.org.
authors.forename: Craig
authors.initials: C
authors.lastname: Conlon
authors.affiliation: Chief of Health Services Research for the Veterans Administration Palo Alto Health Care System in Menlo Park, and Co-Chief of the Division of General Medical Disciplines at Stanford University in Palo Alto, CA. steven.asch@va.gov.
authors.forename: Steven
authors.initials: S
authors.lastname: Asch
authors.affiliation: Senior Project Associate for the RAND Corporation in Santa Monica, CA. mhanson@rand.org.
authors.forename: Mark
authors.initials: M
authors.lastname: Hanson
authors.affiliation: Research Scientist at the Division of Research in Oakland, CA. andy.l.avins@kp.org.
authors.forename: Andrew
authors.initials: A
authors.lastname: Avins
authors.affiliation: Survey Researcher for the RAND Corporation in Santa Monica, CA. blevitan@rand.org.
authors.forename: Barbara
authors.initials: B
authors.lastname: Levitan
authors.affiliation: Project Associate for the RAND Corporation in Santa Monica, CA. roth@rand.org.
authors.forename: Carol
authors.initials: C
authors.lastname: Roth
authors.affiliation: Associate Statistician for the RAND Corporation in Santa Monica, CA. mrobbins@rand.org.
authors.forename: Michael
authors.initials: M
authors.lastname: Robbins
authors.affiliation: Associate Economist for the RAND Corporation in Santa Monica, CA. mdworsky@rand.org.
authors.forename: Michael
authors.initials: M
authors.lastname: Dworsky
authors.affiliation: Associate Professor of Research in Emergency Medicine at the Keck School of Medicine at the University of Southern California in Los Angeles. seabury@usc.edu.
authors.forename: Seth
authors.initials: S
authors.lastname: Seabury
authors.affiliation: Health Services Researcher for the RAND Corporation in Santa Monica and the Director of the Division of Internal Medicine at Cedars-Sinai Medical Center in Los Angeles, CA. teryl.nuckols@cshs.org.
authors.forename: Teryl
authors.initials: T
authors.lastname: Nuckols
mesh_terms: D000328:Adult; D002140:California; D002349:Carpal Tunnel Syndrome / Q000209:etiology / Q000601:surgery / Q000628:therapy*; D019033:Delivery of Health Care, Integrated; D006233:Persons with Disabilities; D005260:Female; D019983:Guideline Adherence; D017048:Health Care Costs; D006268:Health Facilities; D006801:Humans; D008297:Male; D008875:Middle Aged; D009784:Occupational Diseases / Q000601:surgery / Q000628:therapy*; D016272:Occupational Health; D017063:Outcome Assessment, Health Care; D011446:Prospective Studies; D011787:Quality of Health Care; D011788:Quality of Life; D012107:Research Design; D018582:Sick Leave; D011795:Surveys and Questionnaires; D014942:Workers' Compensation