Evidence map›Paper›PMID 30579690›Full record

ArticleThe Journal of hand surgery2019

Variation in Nonsurgical Services for Carpal Tunnel Syndrome Across a Large Integrated Health Care System.

Erika D Sears, Esther L Meerwijk, Eric M Schmidt, Eve A Kerr, Kevin C Chung, Robin N Kamal, Alex H S Harris

Registry-linked trialAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in The Journal of hand surgery, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT04245371 (A Prospective, Randomized, Double-Blind, Cross-over Study of Lidocaine Patch 1.8% in Patients With Moderate to Severe Pain From Carpal Tunnel Syndrome), which is not on this map. Cited by 3 papers.

0numbers the graph read from it
0cells of the map it votes in
3citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT04245371 phase4completednot on this mapstarted 2020, after this paper: background citation

A Prospective, Randomized, Double-Blind, Cross-over Study of Lidocaine Patch 1.8% in Patients With Moderate to Severe Pain From Carpal Tunnel Syndrome

TypeinterventionalSponsorJohn Papakonstantinou, MDRan2020 to 2023Enrolled45ConditionsCarpal Tunnel SyndromeArmsLidocaine 1.8%, Placebo
3 · Its place in the literature

Who cites it

3 citing papers in PubMed.

  1. Article
  2. Article
  3. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

7 authors.

Erika D SearsDepartment of Surgery, Section of Plastic Surgery, Michigan Medicine, Ann Arbor, MI; Veterans Affairs Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI; Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI. Electronic address: endavis@med.umich.edu.
Esther L MeerwijkVeterans Affairs Center for Innovation to Implementation, VA Palo Alto Health Care System, Menlo Park, CA.
Eric M SchmidtVeterans Affairs Center for Innovation to Implementation, VA Palo Alto Health Care System, Menlo Park, CA.
Eve A KerrDepartment of Internal Medicine, Michigan Medicine, Ann Arbor, MI; Veterans Affairs Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI; Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI.
Kevin C ChungDepartment of Surgery, Section of Plastic Surgery, Michigan Medicine, Ann Arbor, MI; Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI.
Robin N KamalDepartment of Orthopaedic Surgery, Stanford University, Palo Alto, CA.
Alex H S HarrisVeterans Affairs Center for Innovation to Implementation, VA Palo Alto Health Care System, Menlo Park, CA; Department of Surgery, Stanford University, Palo Alto, CA.

Funding

Evidence-Based Research in Hand SurgeryK24AR053120 · NIAMS · UNIVERSITY OF MICHIGAN AT ANN ARBOR · PI CHUNG, KEVIN C · 2008 to 2018
$1.6M
Choosing Wisely: Barriers to De-Implementation, Patterns, and Costs of Low Value Preoperative Testing for Veterans Undergoing Low Risk ProceduresI01HX002314 · VA · VETERANS ADMIN PALO ALTO HEALTH CARE SYS · PI MUDUMBAI, SESHADRI, SOX-HARRIS, ALEX · 2018 to 2020
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Assessing Treatment Delay and Resource Use to Improve Value of Pre-Surgical CareIK2HX002592 · VA · VETERANS HEALTH ADMINISTRATION · PI SEARS, ERIKA D · 2018 to 2022
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HSRD VA I01 HX002314HSRD VA IK2 HX002592HSRD VA IK6 HX002840HSRD VA RCS 14-232NIAMS NIH HHS K24 AR053120
6 · The paper itself

Abstract

purposeTo evaluate facility-level variation in the use of services for patients with carpal tunnel syndrome (CTS) receiving care in the Veterans Health Administration (VHA).

methodsA national cohort of VHA patients diagnosed with CTS during fiscal year 2013 was divided into nonsurgical and operative treatment groups for comparison. We assessed the use of 5 types of CTS-related services (electrodiagnostic studies [EDS], imaging, steroid injection, oral steroids, and therapeutic modalities) in the prediagnosis and postdiagnosis periods before any operative intervention at the patient and facility levels.

resultsAmong 72,599 patients newly diagnosed with CTS, 5,666 (7.8%) received carpal tunnel release within 12 months. The remaining 66,933 (92.2%) were in the nonsurgical group. Therapeutic modalities and EDS were the most commonly employed services after the index diagnosis and had large facility-level variation in use. At the facility level, the use of therapeutic modalities ranged from 0% to 93% in the operative group (mean, 32%) compared with 1% to 67% (mean, 30%) in the nonsurgical group. The use of EDS in the postdiagnosis period ranged from 0% to 100% (mean, 59%) in the operative treatment group and 0% to 55% (mean, 26%) in the nonsurgical group at the facility level.

conclusionsThere is wide facility variation in the use of services for CTS among patients receiving operative and nonsurgical treatment. Care delivered by facilities with the highest and lowest rates of service use may suggest overuse and underuse, respectively, of nonsurgical CTS services and a lack of consideration of individual patient factors in making health care decisions regarding use. CLINICAL RELEVANCE: Surgeons must understand the degree of treatment variability for CTS, comprehend the ramifications of large variation in reimbursement and waste in the health care system, and become involved in devising strategies to optimize hand care across all phases of care.

Indexed as

Administration, OralCarpal Tunnel SyndromeCohort StudiesDecompression, SurgicalElectrodiagnosisFemaleGlucocorticoidsHumansInjections, Intra-ArticularMaleMiddle AgedOccupational TherapyOrthotic DevicesPhysical Therapy ModalitiesUnited StatesVeterans Health ServicesGlucocorticoidsCarpal tunnel releasecarpal tunnel syndrometreatment variation

Identifiers

PMID30579690
PMCPMC6400455

What OpenQuestion holds

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Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.