Teryl K. Nuckols, MD

RAND Corporation

2017 ANF Development Grant

  • $245,000

Project Title

The Value of High Quality Electrodiagnostic Study in Work-Associated Carpal Tunnel Syndrome

Project Summary

Carpal Tunnel Syndrome (CTS) is the most common upper-extremity compressive neuropathy syndrome, and its prevalence has dramatically increased in incidence over the past 20 years. Many patients with CTS file workers’ compensation claims. Clinical outcomes are worse for CTS than for other occupational disorders, and deficiencies in quality have been widely documented in healthcare, suggesting potential problems with the quality of care for CTS. Electrodiagnostic (EDX) tests are a fundamental diagnostic modality for suspected CTS, particularly for patients with workers’ compensation claims. However, electrodiagnostic tests are not always performed in accordance with basic quality-of-care standards. Subpar performance and interpretation of electrodiagnostic tests is likely to contribute to variability in treatment. In turn, this is likely to result in poor patient outcomes, longer disability, and higher healthcare expenditures. Improving the quality of diagnostic assessments, including EDX tests, is likely to improve the outcome for CTS treatment and may also lower disability and healthcare costs. This project seeks to assess the quality of EDX tests and its effects on patient outcomes and costs. These are the study's key aims:

Aim One: To assess the quality of EDX studies for the diagnosis of CTS in the workers’ compensation setting.

Aim Two: To examine the relationship between the quality of EDX studies and clinical outcomes for patients with CTS.

Aim Three: To examine the relationship between the quality of EDX studies and the appropriateness and utilization of surgery, total healthcare expenditures for CTS, and duration of temporary disability.