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Hand Call Availability Correlates with Metropolitan Location in TN
Joshua Anthony1; Victoria Poole2; Kevin Sexton, MD3; Melissa Mueller3; Bruce Shack3; Wesley Thayer, MD, PhD3; (1)Meharry Medical College, (2)Purdue University, (3)Vanderbilt University
Vanderbilt University Medical Center, Nashville , TN, USA

Background: Hand trauma is the most frequently treated injury in emergency departments but presently there is a crisis of insufficient emergency coverage. This study evaluates the discrepancy of emergent and elective hand care trends based on trauma level designation, hospital location in a medically underserved area, and hospital location in a rural or metropolitan area in the state of Tennessee.

Methods: We identified 119 hospitals in Tennessee that contained operating and emergency room facilities. Of these, 111 hospitals participated in a survey to determine the availability of elective and emergency hand surgery. Using the American Hospitals Directory website and Health Resources and Services Administration website, we identified the availability of hand specialists, emergency hand call, and elective surgery based on trauma level designation, hospital location in a medically underserved area, and hospital location in a rural or metropolitan area of the 111 hospitals. Logistic regression and Fisher's exact test models were used to analyze the reported measures. All data were analyzed using STATA 12.0 statistical software (StataCorp LP, College Station, TX).

Results: The best predictor for unavailability of emergency hand care is a hospital being located in a rural area (OR 4, P = 0.005, C.I. 1.525 10.49) followed by hospital location in a medically underserved area (OR 3.4, P = 0.008, C.I. 1.378 8.390). Unavailability of hand specialists was similarly predicted by location in a rural area (OR 9, P < 0.001, C.I. 3.577 22.64) followed by location in a medically underserved area (OR 5.6, P < 0.001, C.I. 2.407 12.89). Fifty-five percent of hospitals in rural hospitals offer elective hand surgery while only 12.5% offer emergency hand care (P < 0.001). Sixty-four percent of hospitals in medically underserved hospitals offer elective hand surgery while only 15% offer emergency hand care (P < 0.001).

Conclusions:Our results strongly suggest the presence of a health care disparity for hand trauma between rural and metropolitan areas as well as between medically underserved areas and areas that are not underserved. Despite the lack of overall hand care, most hospitals still offer significantly more elective hand care than emergency hand care. Our findings strongly support the need for increased emergency hand coverage across the state of Tennessee, especially in its rural and medically underserved areas.


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