Craig Conlon1, Steven Asch2, Mark Hanson3, Andrew Avins4, Barbara Levitan5, Carol Roth6, Michael Robbins7, Michael Dworsky8, Seth Seabury9, Teryl Nuckols10. 1. Medical Director of Employee Health Services for Kaiser Permanente in Oakland, CA. craig.x.conlon@kp.org. 2. 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. 3. Senior Project Associate for the RAND Corporation in Santa Monica, CA. mhanson@rand.org. 4. Research Scientist at the Division of Research in Oakland, CA. andy.l.avins@kp.org. 5. Survey Researcher for the RAND Corporation in Santa Monica, CA. blevitan@rand.org. 6. Project Associate for the RAND Corporation in Santa Monica, CA. roth@rand.org. 7. Associate Statistician for the RAND Corporation in Santa Monica, CA. mrobbins@rand.org. 8. Associate Economist for the RAND Corporation in Santa Monica, CA. mdworsky@rand.org. 9. 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. 10. 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.
Abstract
CONTEXT: 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. OBJECTIVE: To describe the design of a study that is assessing quality of care for work-associated CTS and associations with clinical outcomes and costs. DESIGN: 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. MAIN OUTCOME MEASURES: 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. RESULTS: 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). CONCLUSIONS: 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.
CONTEXT: 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. OBJECTIVE: To describe the design of a study that is assessing quality of care for work-associated CTS and associations with clinical outcomes and costs. DESIGN: 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. MAIN OUTCOME MEASURES: 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. RESULTS: 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). CONCLUSIONS: 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: Sheila Leatherman; Donald Berwick; Debra Iles; Lawrence S Lewin; Frank Davidoff; Thomas Nolan; Maureen Bisognano Journal: Health Aff (Millwood) Date: 2003 Mar-Apr Impact factor: 6.301
Authors: Elizabeth A McGlynn; Steven M Asch; John Adams; Joan Keesey; Jennifer Hicks; Alison DeCristofaro; Eve A Kerr Journal: N Engl J Med Date: 2003-06-26 Impact factor: 91.245
Authors: José M Quintana; Antonio Escobar; Inmaculada Arostegui; Amaia Bilbao; Jesús Azkarate; J Ignacio Goenaga; Juan C Arenaza Journal: Arch Intern Med Date: 2006-01-23
Authors: Takahiro Higashi; Paul G Shekelle; John L Adams; Caren J Kamberg; Carol P Roth; David H Solomon; David B Reuben; Lillian Chiang; Catherine H MacLean; John T Chang; Roy T Young; Debra M Saliba; Neil S Wenger Journal: Ann Intern Med Date: 2005-08-16 Impact factor: 25.391
Authors: Teryl Nuckols; Craig Conlon; Michael Robbins; Michael Dworsky; Julie Lai; Carol P Roth; Barbara Levitan; Seth Seabury; Rachana Seelam; Steven M Asch Journal: J Occup Environ Med Date: 2017-01 Impact factor: 2.162
Authors: Teryl K Nuckols; Craig Conlon; Michael Robbins; Michael Dworsky; Julie Lai; Carol P Roth; Barbara Levitan; Seth Seabury; Rachana Seelam; Douglas Benner; Steven M Asch Journal: Muscle Nerve Date: 2018-02-01 Impact factor: 3.217