VA Center for Clinical Management Research
Pre-surgical Care Project
Career Development Award: Assessing Treatment Delay and Resource Use to Improve Value of Pre-Surgical Care
Erika Sears, MD, MS (PI)
Catherine Lu, MPH
Eve Kerr, MD, MPH (Primary)
Kevin Chung, MD, MS
Rod Hayward, MD
Sarah Krein, PhD, RN
4/1/2018 – 3/31/2023
VA Office of Reporting, Analytics, Performance, Improvement and Deployment (RAPID); VA Office of Community Care; VA Physical Medicine and Rehabilitation Program Offices
Background: Carpal tunnel syndrome (CTS) is a common condition among Veterans with approximately 40,000 new diagnoses every year. CTS patients often receive care from one or more providers from primary care, occupational therapy, orthopedic surgery, plastic surgery, neurosurgery, physical medicine and rehabilitation, or pain management disciplines. Although a variety of nonoperative treatments can be appropriate under certain clinical circumstances, these same treatments can be low value if they lead to delays for patients who would benefit from surgery. The pre-surgical period, which includes care delivered between the initial presentation and receipt of a surgery for CTS, is an important time to measure quality and value of care, as patients often have multiple encounters with the healthcare system. However, little attention has been paid to the assessment of care delivered during this time period, offering an opportunity to improve coordination and quality of surgical care for Veterans.
Objectives: The proposed project aims to facilitate development of innovative strategies to improve coordination, access, and value of care for Veterans with CTS, particularly in the pre-surgical period. We will first use VA national data to assess facility-level variation in pre-surgical value for CTS-related care. Value outcomes will be assessed by measuring resource utilization (number of clinical visits) and quality of care (proportion of patients with delay of surgical intervention when symptoms persist). We will also conduct interviews of patients and clinicians to provide a better understanding of the factors associated with pre-surgical value. Finally, we will design and pilot a CTS clinical care pathway based on findings from the initial study aims to incorporate best practices to improve pre-surgical episode value.