# Addressing the Gap in Feasible, Valid, and Important Quality Measures for the Treatment of Carpal Tunnel Syndrome

> **NIH VA I01** · VETERANS ADMIN PALO ALTO HEALTH CARE SYS · 2022 · —

## Abstract

PROJECT SUMMARY/ABSTRACT
Background: Efforts to measure, report, and incentivize the quality of healthcare are now widespread within
the Veterans Health Administration (VA), Medicare, and private healthcare settings—but common
musculoskeletal disorders including carpal tunnel syndrome (CTS) have been omitted from these efforts due to
a lack of valid, feasible quality measures. Although clinical practice guidelines for the diagnosis and
management of CTS have recently been published, no valid and feasible measures of these guidelines
currently exist. Also, great interest exists across healthcare specialties in developing and implementing patient
reported outcome measure-based quality measures (PRO-QMs). Before implementing process or outcome-
based quality measures, it is essential to determine if they are valid and produce actionable information.
Significance/Impact: VA is increasingly becoming a purchaser of community-based healthcare, making it
essential to evaluate if healthcare quality measures are valid for both VA and cross-system comparisons. This
proposal is aligned with VA ORD and HSR&D priorities including quality and safety, supporting the
development of value-based payment models, methods for monitoring quality and safety of non-VA purchased
care, and evaluating measures and methods to compare the quality of VA and non-VA care. The continued
absence of valid CTS quality measures leaves all stakeholders without any means to identify quality gaps,
evaluate the impacts of quality improvement initiatives, or to enact performance-based reimbursement or
purchasing initiatives.
Innovation: Enthusiasm for implementing PRO-QMs has outpaced careful consideration of issues related to
logistics, statistics, measurement, and unintended consequences. Currently, methods are under-developed to
evaluate if sufficient variability in outcomes exist to justify implementation of PRO-QMs. The work proposed in
Aim 2 will significantly advance the conceptual and statistical basis of methods to examine outcome variance
for quality measurement applications. In Aim 3, we propose to examine associations between fully
operationalized and pilot tested process quality measures (Aim 1) with PROMs collected for Aim 2. Information
about each process measure's predictive validity is essential for future prioritization and implementation.
Specific Aims: Aim 1 – Complete development and validity testing of process-oriented quality measures for
the treatment of CTS using diverse administrative datasets. Aim 2 – Evaluate the measurement characteristics
of PRO-QMs for CTS. Aim 3 – Test the predictive validity of promising process measures from Aim 1
Methodology: Existing healthcare data from VA, Medicare, and 3 university and community systems will be
used to examine the measurement characteristics of four currently proposed, but inadequately tested, CTS
process quality measures (Aim 1). Patient reported outcome measures will be collected from 2000 patients in 5
diverse hea...

## Key facts

- **NIH application ID:** 10240300
- **Project number:** 5I01HX003121-02
- **Recipient organization:** VETERANS ADMIN PALO ALTO HEALTH CARE SYS
- **Principal Investigator:** Alex Sox-Harris
- **Activity code:** I01 (R01, R21, SBIR, etc.)
- **Funding institute:** VA
- **Fiscal year:** 2022
- **Award amount:** —
- **Award type:** 5
- **Project period:** 2020-10-01 → 2024-03-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10240300

## Citation

> US National Institutes of Health, RePORTER application 10240300, Addressing the Gap in Feasible, Valid, and Important Quality Measures for the Treatment of Carpal Tunnel Syndrome (5I01HX003121-02). Retrieved via AI Analytics 2026-05-22 from https://api.ai-analytics.org/grant/nih/10240300. Licensed CC0.

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