# Assessing Treatment Delay and Resource Use to Improve Value of Pre-Surgical Care

> **NIH VA IK2** · VETERANS HEALTH ADMINISTRATION · 2022 · —

## Abstract

Episode-based (“bundled”) approaches have been promoted for performance measurement to encourage
shared accountability for the quality and efficiency of healthcare delivery among all of the providers involved in
a patient's care. Most episode-based pilot programs use relatively narrow episode definitions, with the typical
episode trigger starting at the time of a hospitalization or surgery. However, little attention has been paid to
measuring quality and value of pre-surgical care. Although inpatient and postoperative care are costly,
outpatient care accounts for the greatest utilization of health care resources in terms of visits and expenditures.
This pre-surgical period, during which patients often have multiple touches with the healthcare system, is an
important time to identify opportunities to improve coordination and quality of care for Veterans.
The studies proposed as part of this CDA will facilitate development of innovative strategies to improve
coordination, access, and value of care for Veterans with carpal tunnel syndrome (CTS), particularly in the pre-
surgical period. Treatment for CTS is an ideal context to develop measurement models of care quality and
utilization between primary care and specialty providers, given that approximately 40,000 Veterans per year
are newly diagnosed with CTS and often receive care from one or more providers from primary care,
occupational therapy, orthopedic surgery, plastic surgery, neurosurgery, physical medicine and rehabilitation,
or pain management. Although a variety of nonoperative treatments can be appropriate under certain clinical
circumstances, these same treatments can be low value if they lead to delays for patients who would benefit
from surgery. This series of studies to evaluate and improve quality and utilization of CTS pre-surgical care will
advance an understanding of how to optimize coordination of patient-centered surgical care more broadly. This
project will have 3 aims:
Aim 1: Using VHA national data, facility-level variation in CTS pre-surgical value will be assessed by
examining both quality/access (inappropriate delay of surgery) and resource utilization (number of pre-surgical
encounters), while evaluating the impact of key structural and process variables, including referral to
community providers.
Aim 2: Semi-structured interviews with patients and clinicians will be conducted to further identify and better
understand factors associated with pre-surgical episode quality and utilization. Clinicians and patients will be
recruited from 2 facilities with the highest and 2 facilities with the lowest performance on both pre-surgical
measures (quality and utilization) to evaluate perspectives, preferences, organizational factors, and care goals
of key stakeholders (patients and providers) who impact decision-making across phases of pre-surgical CTS
care.
Aim 3: Findings from Aim 1 and Aim 2 will be used to design and pilot a multi-disciplinary CTS clinical care
pathway that addr...

## Key facts

- **NIH application ID:** 10415946
- **Project number:** 5IK2HX002592-05
- **Recipient organization:** VETERANS HEALTH ADMINISTRATION
- **Principal Investigator:** Erika D Sears
- **Activity code:** IK2 (R01, R21, SBIR, etc.)
- **Funding institute:** VA
- **Fiscal year:** 2022
- **Award amount:** —
- **Award type:** 5
- **Project period:** 2018-04-01 → 2023-03-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10415946

## Citation

> US National Institutes of Health, RePORTER application 10415946, Assessing Treatment Delay and Resource Use to Improve Value of Pre-Surgical Care (5IK2HX002592-05). Retrieved via AI Analytics 2026-05-22 from https://api.ai-analytics.org/grant/nih/10415946. Licensed CC0.

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