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REP O RT
RAND/UCLA Quality-of-Care
Measures for Carpal Tunnel
Syndrome
Appendix IV, Part C: Quality Measures:
Materials for Scoring Main Set of Measures
(Data Forms)
Teryl K. NuckolstAnne GriffintSteven M. AschtDouglas A. BennertErika Bruce
Mary CassidytWalter T. ChangtNeil G. HarnesstLiisa HiatttCharles K. Jablecki
Joanne Jeromet Karl J. SandintRebecca ShawtHaoling H. WengtMelinda Maggard Gibbons
Supported by the California Commission on Health and Safety and Workers’ Compensation and by
the Zenith Insurance Company
C EN T ER F OR HE ALTH A N D S AF ETY IN THE WORKPLACE
A study by the RAND Institute for Civil Justice and RAND Health
This research was jointly supported by the California Commission on Health and Safety
and Workers’ Compensation and by the Zenith Insurance Company, and was undertaken
within the RAND Center for Health and Safety in the Workplace.
The R AND Corporation is a nonprofit institution that helps improve policy and
decisionmaking through research and analysis. RAND’s publications do not necessarily
reflect the opinions of its research clients and sponsors.
R® is a registered trademark.
© Copyright 2011 RAND Corporation
Permission is given to duplicate this document for personal use only, as long as it
is unaltered and complete. Copies may not be duplicated for commercial purposes.
Unauthorized posting of RAND documents to a non-RAND website is prohibited. RAND
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Published 2011 by the RAND Corporation
1776 Main Street, P.O. Box 2138, Santa Monica, CA 90407-2138
1200 South Hayes Street, Arlington, VA 22202-5050
4570 Fifth Avenue, Suite 600, Pittsburgh, PA 15213-2665
RAND URL: http://www.rand.org
To order RAND documents or to obtain additional information, contact
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Main Set of Quality Measures: Data Form
Section 1: Ancillary Variables: Demographics and
Determining Study Hand
Response Options
Subject Identification Number
1.01.V Basis for Patient Selection: Administrative data used
1.02.V Study Eligibility: Patient has history of hand or forearm
complaints
_____________________________
1 .01.V
1.02.V
1.03.V Age at End of Study Period
1.03.V
1.04.V Gender
1.04.V
1.05.V Race
1.05.V
Neurologic disease other than CTS
1
Non-neurologic disease
2
CTS without surgery
3
CTS with surgery
4
Other selection method
5
Yes
1
No
2
Unclear/Missing
3
_____________________________
Male
1
Female
2
White
1
Black
2
American Indian/Alaska Native
3
Asian
4
Native Hawaiian or Other Pacific Islander 5
More than one race 6
1.06.V Ethnicity
1.06.V
Unclear/missing
7
Hispanic or Latino
1
Non-Hispanic or not Latino
2
Unclear/missing
3
1.07.V Occupation
1.07.V
____________________________
1.08.V Zip Code
1.08.V
_____________________________
Appendix IV: Main Set of Quality Measures: Data Form
IV-C-1
Response Options
Section 1: Ancillary Variables: Demographics and
Determining Study Hand
1.09.V Hand with Workers’ Compensation Claim
1.10.V Handedness
1.11.V Bilateral Symptoms
1.12.V Hand That Developed Symptoms First
1.13.V Study Hand When Patient Has Bilateral Symptoms
1.09.V
Right hand
1
Left hand
2
Both hands
3
Unclear/missing
4
Right hand
1
Left hand
2
Unclear/Missing
3
Yes
1
No
2
Unclear/Missing
3
Right hand
1
Left hand
2
Unclear/Missing
3
1st choice: one hand covered by claim
1
If both hands covered, 2nd choice: hand with sx first
2
1.10.V
1.11.V
1.12.V
1 .13.V
rd
3 choice: dominant hand
th
4 choice: right hand
3
4
th
If neither hand covered, 5 choice: hand with sx first 5
6th choice: dominant hand
th
7 choice: right hand
Appendix IV: Main Set of Quality Measures: Data Form
6
7
IV-C-2
Section 2: Milestones in Clinical Course and Workers’ Compensation
Claim for the Current Episode of CTS
Milestones From Medical Record
2.01.V Documentation of Presentation
2.02.V Evaluation
2.03.V Suspicion
2.04.V Diagnosis
2.05.V Work-association
2.06.V Off Work
2.07.V Surgery
2.08.V Release to Return to Work
From Initial Workers’ Compensation Claim Form
2.09.V Date of Injury or Illness
2.10.V Date of Examination or Treatment
Appendix IV: Main Set of Quality Measures: Data Form
Milestone #
Date
1
2
3
4
5
6
7
8
2.01.V
2.02.V
2.03.V
2.04.V
2.05.V
2.06.V
2.07.V
2.08.V
n/a
n/a
2.09.V
2.10.V
IV-C-3
Measures
Measure Eligibility
Measure Component
Measure Adherence
Section 3: CTS as possible cause of
symptoms
3.01.E Eligibility for measures in Section 3
3.01.E
Eligible 1
Not Eligible 2
3.02.M New symptoms characteristic of
CTS require detailed assessment
3.03.M New symptoms characteristic of
CTS should lead to suspicion
3.03.ME
3.02.MC.1
Location 1
3.02.MC.2
Quality 2
3.02.MC.3
Duration 3
3.02.MC.4
Onset 4
Pass 1
No Pass 2
3.03.MA
Eligible 1
Not Eligible
3.02.MA
2
Pass 1
No Pass 2
Section 4: Symptoms and signs of CTS
vs. other conditions
4.01.M New hand or forearm pain requires
evaluation for “red flags”
4.02.M New suspicion of CTS requires
specific physical examination
4.03.M New symptoms inconsistent with
CTS require evaluation
4.01.ME
Eligible 1
4.01.MC.1
Trauma 1
2
4.01.MC.2
Deformity 2
4.01.MC.3
Fever 3
Eligible 1
4.02.MC.1
Sensibility 1
2
4.02.MC.2
Strength 2
4.02.MC.3
Atrophy 3
Not Eligible
4.02.ME
Not Eligible
4.03.ME
Eligible 1
Not Eligible
4.01.MA
Pass 1
No Pass
4.02.MA
Pass 1
No Pass
4.03.MA
2
2
2
Pass 1
No Pass 2
Section 5: Imaging Studies
5.01.M Imaging should be used selectively
for suspected CTS
5.01.ME
Appendix IV: Main Set of Quality Measures: Data Form
Eligible 1
Not Eligible
2
5.01.MA
Pass 1
No Pass 2
IV-C-4
Measures
Measure Eligibility
Measure Component
Measure Adherence
Section 6: Non-Occupational Risk
Factors and Exacerbating Factors
Subsection 6A: Medical Risk Factors
6.01.M New suspicion of CTS requires
evaluation for excessive weight
6.01.ME
6.02.E Eligibility for 6.03.M and 6.04.M
6.02.E
6.01.MA
Eligible 1
Not Eligible
2
Pass 1
No Pass 2
Eligible 1
Not Eligible 2
6.03.M New CTS diagnosis requires
assessment of medical risk factors
6.03.MC.1
Arthritis 1
6.03.MC.2
Diabetes 2
6.03.MA
Pass 1
No Pass 2
6.03.MC.3 Hypothyroid 3
6.03.MC.4
Pregnancy 4
6.03.MC.5
Kidney Dz 5
6.04.MC.1
Force 1
6.04.MC.2
Vibration 2
6.04.MC.3
Frequency 3
Subsection 6B: Non-Occupational
Exacerbating Factors
6.04.M New CTS diagnosis requires
assessment of non-occupational factors
6.04.MA
Pass 1
No Pass
2
Section 7: Work-Associated CTS
Symptoms
7.01.E Eligibility for Sections 7 to 15:
Milestone 4 (CTS diagnosis) occurred
7.01.E
Eligible 1
Not Eligible 2
7A: Occupational Exacerbating Factors
7.02.E Eligibility for measures 7.03.M and
7.04.M: Milestone 2 occurred
Appendix IV: Main Set of Quality Measures: Data Form
7.02.E
Eligible 1
Not Eligible
2
IV-C-5
7.03.M New CTS diagnosis requires
detailed occupational history
7.04.M New CTS diagnosis requires
assessment of occupational factors
7.05.M Exacerbating activities should be
identified when symptoms limit functioning
7.04.ME
7.03.MC.1
Lack of Job 1
7.03.MC.2
Job Duties 2
7.03.MC.3
Duration 3
7.03.MC.4
Timing 4
Eligible 1
7.04.MC.1
Force 1
2
7.04.MC.2
Vibration 2
7.04.MC.3
Frequency 3
Not Eligible
7.05.ME
Pass 1
No Pass 2
7.04.MA
Pass 1
No Pass
7.05.MA
Eligible 1
Not Eligible
7.03.MA
2
2
Pass 1
No Pass 2
7B: Provider Statements Regarding Work
Association
7.06.M. Rationale for work-association
should be documented
7.06.ME
7.06.MA
Eligible 1
Not Eligible
2
Pass 1
No Pass
2
Section 8: Non-operative Treatment
8A: Education and Modified Activity
8.01.M Patients newly diagnosed with CTS
should be educated about the condition
8.01.ME
Eligible 1
8.01.MC.1
Diagnosis 1
2
8.01.MC.2
Treatment 2
8.01.MC.3
Prognosis 3
8.01.MC.4
Activity 4
8.01.MC.5
Rationale 5
Not Eligible
8.01.MA
Pass 1
No Pass 2
8.01.MC.6
Benefits of Working 6
8.01.MC.7
Work Modifications 7
8.01.MC.8
8.02.M Exposures to vibration, force, and
repetition should be minimized
8.02.ME
Appendix IV: Main Set of Quality Measures: Data Form
Eligible 1
Not Eligible
2
Other 8
8.02.MA
Pass 1
No Pass 2
IV-C-6
8B: Splinting
8.03.E Eligibility for Subsection 8B
8.03.E
Eligible 1
Not Eligible 2
8.04.M Splints should be placed in neutral
position
8.05.M An attempt at splinting should last
at least six weeks
8.04.MA
Pass 1
No Pass 2
8.05.ME
Eligible 1
8.05.MA
Not Eligible 2
Pass 1
No Pass
2
8C: Medications
8.06.E Additional Eligibility for Subsection
8C
8.06.E
Eligible 1
Not Eligible
2
8.07.M NSAIDs should not be used for
CTS
8.07.MA
8.08.M Muscle relaxants should not be used
for CTS
8.08.MA
8.09.M Opiates should not be used for CTS
8.09.MA
Pass 1
No Pass 2
Pass 1
No Pass 2
Pass 1
No Pass 2
8.10.M Diuretics should not be used for
CTS
8.10.MA
Pass 1
No Pass 2
8.11.M Steroid treatment requires discussion
of risks
8.11.ME
8.12.M Discuss benefits of surgery when
offering steroids to patients with severe CTS
8.12.ME
8.13.M Limit steroid injections to four
8.13.ME
Eligible 1
8.11.MA
Not Eligible 2
Eligible 1
Not Eligible
Not Eligible
Appendix IV: Main Set of Quality Measures: Data Form
No Pass 2
8.12.MA
2
Eligible 1
2
Pass 1
Pass 1
No Pass 2
8.13.MA
Pass 1
No Pass 2
IV-C-7
Measures
Measure Eligibility
Measure Component
Measure Adherence
8D: Lasers
8.14.M Laser therapy should not be used for
CTS
8.14.ME
8.14.MA
Eligible 1
Not Eligible
2
Pass
1
No Pass
2
Section 9: Follow-up
9A: General Follow-up
9.01.M Symptoms should be monitored
after new diagnosis of CTS
9.01.ME
Eligible 1
Not Eligible
2
9.01.MC.1
Sensory Sx 1
9.01.MC.2
Weakness 2
9.01.MA
Pass 1
No Pass
2
Pass
1
No Pass
2
Pass
1
No Pass
2
Pass
1
No Pass
2
Pass
1
No Pass
2
9B: Work-Associated CTS
9.02.E Eligibility for Subsection 9B
9.02.E
Eligible 1
Not Eligible
9.03.M Work-associated CTS symptoms
require prompt follow-up
9.03.ME
9.04.M Work status should be monitored
when CTS appears work-associated
9.04.ME
9.05.M Steroids for work-associated
symptoms require follow-up
9.05.ME
9.06.E Additional eligibility for 9.07.M and
9.08.M: Milestone 6 occurred
9.06.E
9.07.M Return to work after CTS-related
disability requires follow-up assessment that
includes functional limitations
9.07.ME
Eligible 1
Not Eligible
2
9.04.MA
2
Eligible 1
Not Eligible
9.05.MA
2
Eligible 1
Not Eligible
Appendix IV: Main Set of Quality Measures: Data Form
9.03.MA
Eligible 1
Not Eligible
9.08.M Prolonged CTS-related disability
should trigger evaluation
2
2
9.07.MA
Eligible 1
Not Eligible
2
9.08.MC.1
Substances 1
9.08.MC.2
Psychiatric 2
9.08.MC.3
Other 3
9.08.MA
Pass 1
No Pass
2
IV-C-8
Section 10: Surgical Decision-making
10.01.E First Carpal Tunnel Release Surgery
during Study Period
10.01.E
First Release 1
No Release 2
Prior Release 3
Unclear/Missing 4
10.02.E Completeness of Preoperative
Medical Record
10.02.E
Complete 1
Incomplete 2
10.03.V to 10.08.V Symptoms and Signs
10.09.V Severity Summary
Score in table at end
1 0.09.V
Severe 1
Moderate 2
Mild 3
CTS Unlikely 4
10.10.V Probability Summary
10.10.V High Probability 1
Not High Probability 2
10.11.V to 10.13.V Prior Treatments and
Tests
10.11.V Conservative Therapy Summary
10.11.V
Failed Attempt 1
10.11.MC.1
Activity 1
No Failed Attempt 2
10.11.MC.2
Splinting 2
10.11.MC.3
Steroid Inj 3
10.11.MC.4
Success 4
10.11.MC.5 No Attempt 5
10.11.MC.6
Appendix IV: Main Set of Quality Measures: Data Form
Unclear 6
IV-C-9
10.12.V Electrodiagnosis Summary
10.12.V
Positive 1
Indeterminate 2
Negative 3
No Test 4
10.13.V Duration Summary
10.13.V
> 12 Months 1
3 to 12 Months 2
< 3 Months 3
Section 11: Compelling Indications for
Carpal Tunnel Surgery
11.01.M Indications for carpal tunnel
surgery are not changed by diabetes
11.01.ME
11.02.M Prompt surgery in wrist injury
11.02.ME
Eligible 1
11.01.MA
Not Eligible 2
Eligible 1
No Pass 2
11.02.MA
Not Eligible 2
11.03.M Compelling indications for surgery
when CTS is MILD
11.03.ME
11.04.M Compelling indications for surgery
when CTS is MODERATE, part I
11.04.ME
11.05.M Compelling indications for surgery
when CTS is MODERATE, part II
11.05.ME
11.06.M Compelling indications for surgery
when CTS is SEVERE, part I
11.06.ME
11.07.M Compelling indications for surgery
when CTS is SEVERE, part II
11.07.ME
11.08.M Compelling indications for surgery
when CTS is SEVERE, part III
11.08.ME
Eligible 1
11.03.MA
11.04.MA
Not Eligible 2
Eligible 1
11.05.MA
11.06.MA
Appendix IV: Main Set of Quality Measures: Data Form
Not Eligible 2
No Pass
2
Pass 1
Pass 1
Pass 1
No Pass 2
11.07.MA
Not Eligible 2
Eligible 1
1
No Pass 2
Not Eligible 2
Eligible 1
Pass
No Pass 2
Not Eligible 2
Eligible 1
Pass 1
No Pass 2
Not Eligible 2
Eligible 1
Pass 1
Pass 1
No Pass 2
11.08.MA
Pass 1
No Pass 2
IV-C-10
Section 12: Compelling ContraIndications to Carpal Tunnel Surgery
12.01.M Avoidance of carpal tunnel surgery
during pregnancy
12.01.ME
Eligible 1
Not Eligible 2
12.02.M Compelling CONTRA-indications
for surgery when CTS is MILD, part I
12.02.ME
12.03.M Compelling CONTRA-indications
for surgery when CTS is MILD, part II
12.03.ME
12.04.M Compelling CONTRA-indications
for surgery when CTS is MODERATE,
part I
12.04.ME
12.05.M Compelling CONTRA-indications
for surgery when CTS is MODERATE,
part II
12.05.ME
12.06.M Compelling CONTRA-indications
for surgery when CTS is MODERATE, part
III
12.06.ME
12.07.M Compelling CONTRA-indications
for surgery when CTS is MODERATE, part
IV
12.07.ME
12.01.MA
12.01.MC.1
No Pass 2
Pain or Severe Impairment 1
12.01.MC.2
Splinting 2
12.01.MC.3
Steroid Inj 3
13.01.MC.1
History 1
Pass 1
Eligible 1
Not Eligible 2
Eligible 1
Not Eligible 2
Eligible 1
Not Eligible 2
Eligible 1
Not Eligible 2
Eligible 1
Not Eligible 2
Eligible 1
Not Eligible 2
Section 13: Perioperative Care
13.01.M Elements of CTS-specific surgical
evaluation
Appendix IV: Main Set of Quality Measures: Data Form
Pass 1
No Pass 2
13.01.MC.2 Examination 2
13.01.MC.3
13.02.M Documentation of prior treatments
for CTS
13.01.MA
EDX 3
13.02.MA
Pass 1
No Pass 2
IV-C-11
13.03.M Preoperative evaluation of
suspected cervical radiculopathy
13.03.ME
13.04.M Preoperative electrodiagnostic
testing for work-associated CTS
13.04.ME
Eligible 1
13.03.MA
Not Eligible 2
Eligible 1
Pass 1
No Pass 2
13.04.MA
Not Eligible 2
Pass 1
No Pass 2
13.05.M Recent preoperative visit with
surgical team
13.05.MA
13.06.M Elements of general preoperative
history: Medical co-morbidities
13.06.MA
13.07.M Elements of general preoperative
history: Past surgical history
13.07.MA
13.08.M Elements of general preoperative
history: Current medications
13.08.MA
13.9.M Elements of general preoperative
history: “Allergies”
13.09.MA
13.10.M Elements of general preoperative
history: Review of systems including at least
two organ systems
13.10.MA
Pass 1
No Pass 2
Pass 1
No Pass 2
Pass 1
No Pass 2
Pass 1
No Pass 2
Pass 1
No Pass 2
Pass 1
No Pass 2
13.11.M Consent for open procedure in
planned endoscopic release
13.11.ME
13.12.M Requirement for a postoperative
visit
13.12.ME
13.13.M Elements of postoperative visit
with surgical team
13.13.ME
13.14.M Monitoring of postoperative
stiffness
13.14.ME
Eligible 1
13.11.MA
Not Eligible 2
Eligible 1
No Pass 2
13.12.MA
Not Eligible 2
Eligible 1
Appendix IV: Main Set of Quality Measures: Data Form
Not Eligible 2
Pass 1
No Pass 2
13.13.MA
Not Eligible 2
Eligible 1
Pass 1
Pass 1
No Pass 2
13.14.MA
Pass 1
No Pass 2
IV-C-12
13.15.M Management of postoperative
finger stiffness
13.15.ME
13.16.M Patients who do not improve after
surgery require evaluation
13.16.ME
13.17.M Management of lack of
improvement after surgery
13.17.ME
Eligible 1
13.15.MA
Not Eligible 2
No Pass 2
Eligible 1
13.16.MA
Not Eligible 2
Appendix IV: Main Set of Quality Measures: Data Form
Pass 1
Pass 1
No Pass 2
Eligible 1
13.17.MC.1
Testing 1
Not Eligible 2
13.17.MC.2
Referral 2
13.17.MC.3
Refusal 3
13.17.MA
Pass 1
No Pass 2
IV-C-13
Section 10, Symptoms and Signs Table: Score 10.03.V - 10.08.V. List visits chronologically. Use extra sheets if necessary.
Note for data entry: If additional sheets are used, variables numbers can be increased by one for each additional visit date, such as 10.03.V.5, 10.03.V.6, etc.
10.03.V
Visit Date
10.03.V.1
__________
10.03.V.2
__________
10.03.V.3
__________
10.03.V.4
10.04.V Location of
symptoms in hand?
10.04.V.1
Classic/probable
Possible
Unlikely
Unclear / Missing
10.04.V.2
Classic/probable
Possible
Unlikely
Unclear / Missing
10.04.V.3
Classic/probable
Possible
Unlikely
Unclear / Missing
10.04.V.4
Classic/probable
Possible
Unlikely
Unclear / Missing
10.05.V Timing of
symptoms?
10.05.V.1
1
2
3
4
Constant 1
Intermittent 2
Unclear / Missing 3
10.05.V.2
1
2
3
4
Constant 1
Intermittent 2
Unclear / Missing 3
10.05.V.3
1
2
3
4
Constant 1
Intermittent 2
Unclear / Missing 3
10.05.V.4
10.06.V Thenar
atrophy?
10.07.V Weak thenar
muscles on exam?
10.08.V Loss of
sensibility, digits 1-3?
10.06.V.1
Noted as Present 1
Noted as Absent 2
Unclear / Missing 3
10.07.V.1
Noted as Present 1
Noted as Absent 2
Unclear / Missing 3
10.08.V.1
Noted as Present 1
Noted as Absent 2
Unclear / Missing 3
10.06.V.2
Noted as Present 1
Noted as Absent 2
Unclear / Missing 3
10.07.V.2
Noted as Present 1
Noted as Absent 2
Unclear / Missing 3
10.08.V.2
Noted as Present 1
Noted as Absent 2
Unclear / Missing 3
10.06.V.3
Noted as Present 1
Noted as Absent 2
Unclear / Missing 3
10.07.V.3
Noted as Present 1
Noted as Absent 2
Unclear / Missing 3
10.08.V.3
Noted as Present 1
Noted as Absent 2
Unclear / Missing 3
10.07.V.4
Noted as Present 1
Noted as Absent 2
Unclear / Missing 3
10.08.V.4
Noted as Present 1
Noted as Absent 2
Unclear / Missing 3
10.07.V.Summary
Present 1
Absent 2
10.08.V.Summary
Present 1
Absent 2
1
2
3
4
Constant 1
Intermittent 2
Unclear / Missing 3
10.06.V.4
Noted as Present 1
Noted as Absent 2
Unclear / Missing 3
Most severe
10.04.V.Summary
findings across
Classic/probable 1
all listed visits.
Possible 2
Unlikely 3
10.05.V.Summary
Constant 1
Intermittent 2
10.06.V.Summary
Present 1
Absent 2
__________
Appendix IV: Main Set of Quality Measures: Data Form
IV-C-14