Surgical Timing for Carpal Tunnel Syndrome: A Comparison of Health Care Delivery in the Veterans Administration and Private Sector

摘要: Purpose The U.S. Department of Veterans Affairs (VA) health care system monitors time from referral to specialist visit. We compared wait times for carpal tunnel release (CTR) at a VA hospital and its academic affiliate. Methods selected patients who underwent CTR affiliate (AA) (2010–2015). analyzed primary physician (PCP) CTR, which was subdivided into PCP surgical consultation CTR. Electrodiagnostic testing (EDS) categorized in relation (prereferral vs postreferral). Multivariable Cox proportional hazard models were used examine associations between clinical variables location. Results Between 2010 2015, had shorter median (VA: 168 days; AA: 410 days), 43 191 but longer 98 55 days). Using multivariable models, the associated with 35% (AA ratio [HR], 0.65; 95% confidence interval [CI], 0.52–0.82) 75% HR, 0.25; CI, 0.20–0.03). Receiving both prereferral postreferral EDS almost 2-fold prolonged 0.49; 0.36–0.67). Conclusions overall AA. However, policy prioritizing may not optimally incentivize surgery. Repeat systems. Clinical Relevance Given differences where delays occur each system, initiatives improve efficiency will require targeting appropriate sources preoperative delay. Judicious use be one avenue decrease