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American Association for Hand Surgery

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Evaluating the Distribution of Emergent Hand Care in Tennessee across Metro and Micropolitan Statistical Areas
Darren P Ruiz, B.S.1, Mykia S Lee, M.S.1, Adam G Evans, M.D.2 and J. Bradford Hill, M.D.2, (1)Meharry Medical College, Nashville, TN, (2)Vanderbilt University Medical Center, Nashville, TN

Introduction: Hand injuries, such as contusions, fractures, and infections, are common causes of visits to the emergency department. Across the state of Tennessee, it has been reported that only 32% of hospitals offer operative hand treatment. Additionally, only 15% of the hospitals employ a hand specialist. The present study investigates which Tennessee counties have a disparity in hand treatment and establishes predictive factors for the presence of a hand surgery disparity.
Materials & Methods: 2019 census population estimates were used to acquire demographic details of Tennessee counties. All counties were stratified as either metropolitan (>50,000 individuals), micropolitan (10,000-50,000 individuals), or other (<10,000 individuals), according to the Office of Management and Budget standards. Hospital services data was acquired from a 2018 survey of Tennessee Hospital Association registered hospitals. Chi-squared and independent t-tests were performed to assess for county demographic factors associated with hand surgery disparities.
Results: 119 Tennessee hospitals were identified as having an emergency department, of which data concerning both hospital acceptance of hand trauma and availability of hand specialists were available from 97 (82%) hospitals. 66 were in metropolitan counties, 17 were in micropolitan counties, and 14 were in other counties. The included hospitals were located in counties that were on average 82% (s.d. 18%) white, 14% (s.d. 17%) black, 5% (s.d. 3%) Hispanic, 2% (s.d. 1%) Asian, and 1% (s.d. 0%) other. The mean population proportion aged 65 or older was 17% (s.d. 4%), and the median household income was $51,000 (s.d. $11,000). Rural (micropolitan or other) counties were less likely to accept hand trauma (P = .019) and to have a hand specialist on call (P = .001). Increased population proportion over age 65 as well as increased white counties were less likely to accept hand trauma (P = .004 and P = .011, respectively), and to have a hand specialist on call (P < .001 and P < .001, respectively). Hospitals located in counties with a higher median household income were also more likely to accept hand trauma (P = .009) and to have a hand specialist on call (P = .013).
Conclusion: Individuals residing in more rural, older, less affluent, and more ethnically white counties across Tennessee are more likely to reside in counties without hand specialists and local surgical care for hand injuries. Health care systems should investigate methods of reducing the impact of this disparity.


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