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Quality of Care for Work-Associated Carpal Tunnel Syndrome

Nuckols, Teryl MD, MSHS; Conlon, Craig MD, PhD; Robbins, Michael PhD; Dworsky, Michael PhD; Lai, Julie MPH; Roth, Carol P. BSN, MPH; Levitan, Barbara BA; Seabury, Seth PhD; Seelam, Rachana MPH; Asch, Steven M. MD, MPH

Journal of Occupational and Environmental Medicine: January 2017 - Volume 59 - Issue 1 - p 47–53
doi: 10.1097/JOM.0000000000000916

Objective: To evaluate the quality of care provided to individuals with workers’ compensation claims related to Carpal tunnel syndrome (CTS) and identify patient characteristics associated with receiving better care.

Methods: We recruited subjects with new claims for CTS from 30 occupational clinics affiliated with Kaiser Permanente Northern California. We applied 45 process-oriented quality measures to 477 subjects’ medical records, and performed multivariate logistic regression to identify patient characteristics associated with quality.

Results: Overall, 81.6% of care adhered to recommended standards. Certain tasks related to assessing and managing activity were underused. Patients with classic/probable Katz diagrams, positive electrodiagnostic tests, and higher incomes received better care. However, age, sex, and race/ethnicity were not associated with quality.

Conclusions: Care processes for work-associated CTS frequently adhered to quality measures. Clinical factors were more strongly associated with quality than demographic and socioeconomic ones.

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RAND Corporation, Santa Monica (Dr Nuckols, Dr Robbins, Dr Dworsky, Ms Lai, Ms Roth, Ms Levitan, Ms Seelam, Dr Asch); Division of General Internal Medicine, Cedars-Sinai Medical Center (Dr Nuckols); Employee Health, The Permanente Medical Group, Oakland (Dr Conlon); University of Southern California, USC Schaeffer Center (Dr Seabury), Los Angeles; VA Palo Alto Health Care System, Menlo Park (Dr Asch); and Division of General Medical Disciplines, Stanford University School of Medicine, Stanford, Palo Alto (Dr Asch), California.

Address correspondence to: Teryl Nuckols, MD, MSHS, RAND Corporation, 1776 Main Street; Santa Monica, CA 90401 (

Authors’ Contributions to the Research: Teryl Nuckols and Steven M. Asch jointly designed and oversaw all aspects of the work. Craig Conlon served as site principal investigator, overseeing data collection and providing input on issues related to care for CTS and workers’ compensation. Michael Robbins oversaw statistical analyses. Michael Dworsky provided input on issues related to workers’ compensation and assisted with data analysis and interpretation. Julie Lai and Rachana performed statistical analyses. Carol P. Roth assisted with the design of and oversaw the completion of the medical record reviews. Seth Seabury and John Adams contributed to study design, analytical methods, and interpretation of results. Barbara Levitan assisted with the design of and oversaw the completion of the surveys. Author Access to Data: All authors had access to study data. Payment for the Work: All authors received payment for the work, except John Adams, who donated his time.

This work was funded by a grant from the Agency for Healthcare Research and Quality (5R01HS018982–03). Prior stages in the work (quality measure development) were supported with funding from the California Commission on Health and Safety and Workers’ Compensation (CHSWC) and with an unrestricted gift from Zenith Insurance. CHSWC is a state-sponsored joint labor-management body charged with examining the health and safety and workers’ compensation systems in California and recommending administrative or legislative modifications to improve their operation. Zenith Insurance specializes in workers’ compensation insurance. The funders played no role in the design, conduct, or reporting of this work.

RAND has received funding from Insurance and Care NSW, Australia (Nuckols), and from the Collaborative Spine Research Foundation (Nuckols). The authors have no other potential conflicts of interest to report.

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Copyright © 2017 by the American College of Occupational and Environmental Medicine