TY - JOUR
T1 - Variation in Use of Electrodiagnostic Testing
T2 - Analysis From the Michigan Collaborative Hand Initiative for Quality in Surgery
AU - M-CHIQS Collaborators
AU - Billig, Jessica I.
AU - Kotsis, Sandra V.
AU - Chung, Kevin C.
AU - Adkinson, Joshua
AU - Fowler, John
AU - Gaston, R. Glenn
AU - Giladi, Aviram
AU - Gottschalk, Michael
AU - Hammert, Warren
AU - Katz, Ryan
AU - Li, Zhongyu John
AU - Rizzo, Marco
AU - Wagner, Eric
N1 - Funding Information:
Research reported in this publication was supported by funds from the American Foundation for Surgery of the Hand. K.C.C. receives research funding from the National Institutes of Health , book royalties from Wolters Kluwer and Elsevier, and funding from Axogen . The funding organizations had no role in the design and conduct of the study, including collection, management, analysis, and interpretation of the data. The content is solely the responsibility of the authors and does not necessarily represent the official views of the U.S. government or Veterans Administration.
Funding Information:
Research reported in this publication was supported by funds from the American Foundation for Surgery of the Hand. K.C.C. receives research funding from the National Institutes of Health, book royalties from Wolters Kluwer and Elsevier, and funding from Axogen. The funding organizations had no role in the design and conduct of the study, including collection, management, analysis, and interpretation of the data. The content is solely the responsibility of the authors and does not necessarily represent the official views of the U.S. government or Veterans Administration. The M-CHIQS Collaborators are Joshua Adkinson, MD; John Fowler, MD; R. Glenn Gaston, MD; Aviram Giladi, MD, MS; Michael Gottschalk, MD; Warren Hammert, DDS, MD; Ryan Katz, MD; Zhongyu John Li, MD, PhD; Marco Rizzo, MD; and Eric Wagner MD, MS. We want to thank the M-CHIQS study coordinators Natalie Baxter (University of Michigan, Ann Arbor, MI); Christian Cuevas (Indiana University Health, Indianapolis, IN); Karen Wasil and Brooke Marshall (University of Pittsburgh, Pittsburgh, PA); Danielle Drossart and Carter Gunn (OrthoCarolina Hand Center, Charlotte, NC); Ike Fleming, Imran Yousaf, Kezia Alexander, Pragna Shetty, Lumanti Manandhar, Flossine Brown, Alessandra Butanis (Curtis National Hand Center, Baltimore, MD); Alexander Dawes (Emory Orthopaedics, Sports & Spine, Atlanta, GA); Raechel Argento (University of Rochester, Rochester, NY); Rachel Bordelon (Wake Forest Baptist Health, Winston-Salem, NC); and Taylor Trentadue (Mayo Clinic, Rochester, MN).
Publisher Copyright:
© 2021 American Society for Surgery of the Hand
PY - 2021/3
Y1 - 2021/3
N2 - Purpose: To evaluate factors that predict the use of electrodiagnostic testing (EDS) for patients undergoing carpal tunnel release (CTR). Methods: In this cohort study, we analyzed 553 patients who underwent primary CTR from 8 practices between July 1, 2019 and December 1, 2019 by 32 surgeons in the Michigan Collaborative Hand Initiative for Quality in Surgery (M-CHIQS). The M-CHIQS is a collaborative initiative aimed at improving quality in hand surgery. Demographic and clinical characteristics were collected, including the 6-item carpal tunnel symptoms scale (CTS-6) scores and EDS timing. Multilevel logistic regression was used to assess practice and surgeon variation in EDS use related to clinical diagnostic criteria. Results: Of the 553 patients who underwent CTR during the study period, 461 (83.3%) received preoperative EDS. After controlling for patient clinical and demographic characteristics, CTS-6 scores were not associated with receiving any preoperative EDS (lower probability of CTS: odds ratio [OR], 0.94; 95% confidence interval [95% CI], 0.59–1.51), preconsultation EDS (low probability of CTS: OR, 1.00; 95% CI, 0.73–1.38), or postconsultation EDS (low probability of CTS, OR, 1.10; 95% CI, 0.77–1.60). For use of any EDS, 9.3% of the variation in testing was explained at the practice level and 31.1% of the variation in testing was explained at the surgeon level. Conclusions: Variation in EDS use is explained primarily at the practice and surgeon levels and is not related to patient clinical criteria. We recommend that providers and practices assess their use of preoperative EDS and limit its use to patients with an unclear clinical CTS diagnosis, as stated in current clinical practice guidelines. Likewise, providers should be encouraged to use the CTS-6 before prescribing EDS. Clinical relevance: Limiting the use of EDS to patients with an unclear clinical diagnosis of CTS will reduce costs and improve patient care by eliminating the discomfort and time associated with this test.
AB - Purpose: To evaluate factors that predict the use of electrodiagnostic testing (EDS) for patients undergoing carpal tunnel release (CTR). Methods: In this cohort study, we analyzed 553 patients who underwent primary CTR from 8 practices between July 1, 2019 and December 1, 2019 by 32 surgeons in the Michigan Collaborative Hand Initiative for Quality in Surgery (M-CHIQS). The M-CHIQS is a collaborative initiative aimed at improving quality in hand surgery. Demographic and clinical characteristics were collected, including the 6-item carpal tunnel symptoms scale (CTS-6) scores and EDS timing. Multilevel logistic regression was used to assess practice and surgeon variation in EDS use related to clinical diagnostic criteria. Results: Of the 553 patients who underwent CTR during the study period, 461 (83.3%) received preoperative EDS. After controlling for patient clinical and demographic characteristics, CTS-6 scores were not associated with receiving any preoperative EDS (lower probability of CTS: odds ratio [OR], 0.94; 95% confidence interval [95% CI], 0.59–1.51), preconsultation EDS (low probability of CTS: OR, 1.00; 95% CI, 0.73–1.38), or postconsultation EDS (low probability of CTS, OR, 1.10; 95% CI, 0.77–1.60). For use of any EDS, 9.3% of the variation in testing was explained at the practice level and 31.1% of the variation in testing was explained at the surgeon level. Conclusions: Variation in EDS use is explained primarily at the practice and surgeon levels and is not related to patient clinical criteria. We recommend that providers and practices assess their use of preoperative EDS and limit its use to patients with an unclear clinical CTS diagnosis, as stated in current clinical practice guidelines. Likewise, providers should be encouraged to use the CTS-6 before prescribing EDS. Clinical relevance: Limiting the use of EDS to patients with an unclear clinical diagnosis of CTS will reduce costs and improve patient care by eliminating the discomfort and time associated with this test.
KW - Carpal tunnel syndrome
KW - electrodiagnostic testing
KW - quality improvement
UR - http://www.scopus.com/inward/record.url?scp=85099155960&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85099155960&partnerID=8YFLogxK
U2 - 10.1016/j.jhsa.2020.11.017
DO - 10.1016/j.jhsa.2020.11.017
M3 - Article
C2 - 33423853
AN - SCOPUS:85099155960
SN - 0363-5023
VL - 46
SP - 169
EP - 177
JO - Journal of Hand Surgery
JF - Journal of Hand Surgery
IS - 3
ER -