Quality of Care for Work-Associated Carpal Tunnel Syndrome

Published in: Journal of Occupational & Environmental Medicine, Volume 59, Issue 1 (January 2017), pages 47-53. doi: 10.1097/JOM.0000000000000916

by Teryl K. Nuckols, Craig Conlon, Michael W. Robbins, Michael Dworsky, Julie Lai, Carol P. Roth, Barbara Levitan, Seth A. Seabury, Rachana Seelam, Steven M. Asch

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Research Questions

  1. What was the quality of care provided in an integrated health system to people with workers' compensation claims for suspected or confirmed carpal tunnel syndrome (CTS)?
  2. What characteristics of patients were associated with care quality?


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.


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.


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.


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

Key Findings

  • Occupational care provided in an integrated health care system in Northern California adhered to recommended standards of care over 80 percent of the time.
  • Some aspects of care were underused, such as monitoring of symptoms, function, and work status, as well as assessment and management of activities that could exacerbate CTS symptoms.
  • There was little evidence of overuse of steroid injections, imaging studies, or surgery.
  • Quality of care differed modestly by patient income, but did not differ by age, sex, or race/ethnicity.

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