Our Vision

A healthcare system designed by patients

Our Mission

To develop tools to improve the delivery of patient-centered care


VOICES Center for Health Policy is focused on improving the health of patients with musculoskeletal conditions. We use qualitative and quantitative methods to develop tools that improve the delivery of patient-centered care.

Our Research

Patient values and preferences should drive healthcare decisions.  Patients, and how they define quality, should be how our health system defines “quality.”  Our goal is to create these definitions from the patient perspective and create tools to improve healthcare delivery. 


We have developed several tools for preference elicitation in common orthopaedic conditions. These tools educate patients about their diagnosis and treatment options to help patients make a decision that aligns with their values and preferences

Recent Publications

Clinical Care Redesign to Improve Value for Trigger Finger Release: A Before-and-After Quality Improvement Study

Burn MB, Shapiro LM, Eppler SL, Behal R, Kamal RN. 

Trigger finger release (TFR) is a commonly performed procedure. However, there is great variation in the setting, care pathway, anesthetic, and cost. We compared the institutional cost for isolated TFR before and after redesigning our clinical care pathway.

From pre- to post-implementation, the study surgeon’s total direct cost decreased by 18%, while the control surgeons decreased by 2%. Median time spent at the surgery center decreased by 41 minutes post-implementation with significantly shorter setup time in the operating room (OR), total time in the OR, and time spent in recovery prior to discharge.

Click here to access the article.

Patient Willingness to Pay for Faster Return to Work of Smaller Incisions.

Alokozai A, Lindsay SE, Eppler SL, Fox PM, Ladd AL, Kamal RN. 

The primary aim of this exploratory study was to assess hand surgery patient willingness to pay supplementary out-of-pocket charges for a procedure that theoretically leads to an earlier return to work or smaller incisions when there are 2 procedures that lead to similar results (clinical equipoise). 

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Physical and Occupational Therapy Use and Cost After Common Hand Procedures.

Shah RF, Zhang S, Li K, Baker L, Sox-Harris A, Kamal RN. 

The use of routine physical therapy (PT) and occupational therapy (OT) after certain hand procedures, such as carpal tunnel release, remains controversial. The objective of this study was to evaluate baseline use, the change in use, variation in prescribing patterns by region, and costs for PT/OT after common hand procedures.

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Performance Metrics in Hand Surgery: Turning a Blind Eye Will Cost You.

Roe AK, Gil JA, Kamal RN. 

The Medicare Access and Children's Health Insurance Program Reauthorization Act established the Quality Payment Program (QPP), which mandates that physicians who meet the threshold in volume of Medicare patients for whom they care participate in this program through either advanced Alternative Payment Models or the Merit-Based Incentive Payment System. Anticipating physicians' concerns regarding the burden of implementing the QPP, feedback from physicians became a critical component of the continued implementation process in 2018. The purpose of this review is to inform hand surgeons regarding the current QPP (early 2019) and for future observation periods.

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