Purpose
The American Academy of Orthopaedic Surgeons and the American Society for Surgery
of the Hand developed candidate quality measures for potential inclusion in the Merit-Based
Incentive Program and National Quality Forum in the hope that hand surgeons could
report specialty-specific data. The following measures regarding the management of
carpal tunnel syndrome (CTS) were developed using a Delphi consensus process: (1)
use of magnetic resonance imaging (MRI) for diagnosis of CTS, (2) use of adjunctive
surgical procedures during carpal tunnel release (CTR), and (3) use of formal occupational
and/or physical therapy after CTR. This study simulated attempts to identify outlier
regions in an insurance claims database, which is an important step in establishing
feasibility of these measures.
Methods
Using the Truven Health MarketScan, we identified 643,357 patients who were given
a diagnosis of CTS between 2012 and 2014. We reported the percentage of metropolitan
statistical areas (MSA) with one or more claims for MRI within 90 days of CTS diagnosis,
one or more adjunctive surgical procedures, and one or more formal referrals for physical
and/or occupational therapy within 6 weeks of CTR, and we calculated the rate of use
for each of these diagnostic or treatment modalities. In addition, we report the precision
ratio (signal to noise), SD, and 95% confidence interval.
Results
A high percentage of patients given a diagnosis of CTS did not have MRI (99%), and
the precision ratio was considered high (0.99). Over 30% of all observed MSAs had
at least one claim for MRI as a diagnostic modality in CTS. Most patients (98%) did
not have adjunctive surgical procedures. For the observed years, over 28% of MSAs
had at least one insurance claim for an adjunctive procedure. A total of 86% of patients
did not receive formal occupational or physical therapy after CTR. In addition, 92%
of MSAs had at least one claim for therapy. The precision ratio was considered high
(approximately 0.85).
Conclusions
There is regional variation in the utilization rate of diagnostic MRI for CTS, adjunctive
surgical procedures, and formal referral for physical and occupational therapy. For
the proposed quality measures, outlier regions can be detected in insurance claims
data.
Clinical relevance
Use of MRI in diagnosis, adjunctive surgical procedures, and formal therapy after
surgery are feasible quality measures for the Merit-Based Incentive Program and National
Quality Forum.
Key words
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Article info
Publication history
Published online: July 25, 2020
Accepted:
May 1,
2020
Received:
December 22,
2018
Footnotes
D. Ring received royalties from Wright Medical for elbow plates in the amount of less than $10,000 per year and from Skeletal Dynamics for an internal joint stabilizer elbow in the amount of less than $10,000 per year; is a deputy editor for Hand and Wrist, Journal of Orthopaedic Trauma, and Clinical Orthopaedics and Related Research in the amount of $5000 per year; and received honoraria from meetings of AO North America, AO International, and various hospitals and universities. No benefits in any form have been received or will be received by the other authors related directly or indirectly to the subject of this article.
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© 2020 by the American Society for Surgery of the Hand. All rights reserved.
