In the future, the investigators plan to link their data with area resource files on locally available healthcare services, “because this is a population with high rates of disability, and we can see that a majority of the participants are seen by primary care providers and very few by rheumatologists,” said Dr. Al Snih.
Explore this issueJanuary 2019
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Carpal Tunnel Clinical Care
“Large data sets are extremely powerful. We can use them to describe epidemics, to determine our diets, to estimate risk, to define the typical and, therefore, the atypical—and all of these things are extremely useful to us as clinicians in understanding who we treat and how we treat them,” said Nancy A. Baker, ScD, MPH, OT, associate professor of occupational therapy, Tufts University, Boston. “There are numerous questions that can be asked related to large data sets. We can ask prevalence and incidence questions. We can ask characteristic questions related to specific populations and, maybe, how those differ from general populations. We can look at risk factors and how diseases, treatments or outcomes change over time.”
Dr. Baker studied patterns of clinical care among patients with carpal tunnel syndrome using the Clinformatics Data Mart, a repository of claims reimbursement data from a large U.S. health insurer. Treatment guidelines for carpal tunnel syndrome were published in 2014, recommending surgery for patients with severe disease and conservative care, such as splinting, for others. “But what hasn’t been defined well are what conservative treatments really seem to work well for people with carpal tunnel syndrome,” she said.3,4
Dr. Baker and her co-investigators searched the database for patients diagnosed for the first time with carpal tunnel syndrome from 2010–2012. They tracked each patient over a three-year period after their initial diagnosis to see what treatments they received based on ICD-9 codes.
Out of 19 million eligible patients in the database over 2010–2012, investigators identified 200,532 (1%) patients with a carpal tunnel syndrome diagnosis and filtered this group to a final sample of 24,931 carpal tunnel syndrome patients. These patients each had four years of continuous insurance coverage and a confirmed initial provider visit date.
Often, carpal tunnel syndrome is considered a work-related illness in the U.S. In past studies, treatment seemed to vary greatly depending on a patient’s insurance coverage, said Dr. Baker. Out of six possible treatments—surgery, positioning (splints), corticosteroids, heat-based treatment, manual treatment and therapeutic exercises—this study found 53.5% of patients diagnosed with carpal tunnel syndrome received no treatment at all, and 28.4% received one treatment. Overall, the most common treatment prescribed was surgery, followed by positioning and steroids. Patients who had only a diagnostic office visit were most likely to receive a splint, and patients with two or more visits were more likely to have surgery, she said.