The quality of occupational healthcare for carpal tunnel syndrome, healthcare expenditures, and disability outcomes: A prospective observational study

INTRODUCTION/AIMS: In prior work, higher quality care for work‐associated carpal tunnel syndrome (CTS) was associated with improved symptoms, functional status, and overall health. We sought to examine whether quality of care is associated with healthcare expenditures or disability. METHODS: Among 343 adults with workers' compensation claims for CTS, we created patient‐level aggregate quality scores for underuse (not receiving highly beneficial care) and overuse (receiving care for which risks exceed benefits). We assessed whether each aggregate quality score (0%–100%, 100% = better care) was associated with healthcare expenditures (18‐mo expenditures, any anticipated need for future expenditures) or disability (days on temporary disability, permanent impairment rating at 18 mo). RESULTS: Mean aggregate quality scores were 77.8% (standard deviation [SD] 16.5%) for underuse and 89.2% (SD 11.0%) for overuse. An underuse score of 100% was associated with higher risk‐adjusted 18‐mo expenditures ($3672; 95% confidence interval [CI] $324 to $7021) but not with future expenditures (−0.07 percentage points; 95% CI −0.48 to 0.34), relative to a score of 0%. An overuse score of 100% was associated with lower 18‐mo expenditures (−$4549, 95% CI −$8792 to −$306) and a modestly lower likelihood of future expenditures (−0.62 percentage points, 95% CI −1.23 to −0.02). Quality of care was not associated with disability. DISCUSSION: Improving quality of care could increase or lower short‐term healthcare expenditures, depending on how often care is currently underused or overused. Future research is needed on quality of care in varied workers' compensation contexts, as well as effective and economical strategies for improving quality.