Patient Experience of Presurgical Care for Carpal Tunnel Syndrome Across Treatment Sites in the Veterans Affairs Health System: A Qualitative Analysis.

Purpose: Some variation in presurgical care is inevitable, yet it represents an understudied opportunity to improve the value and standardization of care leading up to surgery. This study aimed to explore differences in patients' presurgical experiences and better understand the factors associated with this variation in care. Methods: This qualitative study involved semistructured interviews with 24 patients receiving care for carpal tunnel syndrome at Veterans Affairs health care facilities, which had been previously stratified by levels of presurgical delay and resource utilization in a prior quantitative study. Interview transcripts were coded via thematic analysis to form an in-depth picture of veterans' experiences and perspectives between these sites. Results: Veterans at high delay/utilization sites more often described long-standing and severe symptoms which disrupted their quality of life, and were more likely to attempt alternative self-treatments. Once care had been established, these veterans reported variable and less well-defined pathways from diagnosis to treatment relative to low delay/utilization sites. Veterans across all sites expressed a desire for timely treatment and definitive outcomes. Conclusions: Patients place high importance on efficient and timely presurgical care. However, there is noted variation in patient-reported experiences of their presurgical care correlating with previously quantified differences in the facilities at which these patients were treated. This variance in patient experience could be due to inconsistencies in provider-patient relationships and communication, care coordination, and lack of standardized pathways for diagnostic testing, referral, or ultimate treatment. Optimizing the presurgical interval and associated treatment pathways could have major impact on the lived experience of patients during presurgical care and may help providers and health systems better understand targets for future quality improvement initiatives. Type of study/level of evidence: Not graded (qualitative).