Mechanisms that affect access to surgical hand care appear to be complex and multifaceted. This scoping review aims to investigate the available literature describing such mechanisms and provide direction for future investigation.
Methods:
The methodological framework outlined by the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Extension for Scoping Reviews was used to guide this review. In November 2021, MEDLINE and EMBASE databases were searched. A narrative summary of the characteristics and key findings of each paper is used to present the data to facilitate the integration of diverse evidence.
Results:
Of 471 initial studies, 49 were included in our final analysis. Of these, 33% were cohort studies; 27% reported that underinsured patients are less likely to get an appointment with a hand specialist or to receive treatment. Overburdened emergency departments accounted for the second-most reported reason (16%) for diminished access to surgical hand care. Elective procedure financial incentives, poor emergency surgical hand coverage, distance to treatment, race, and policy were also notably reported across the literature.
Conclusions:
This study describes the vast mechanisms that hinder access to surgical hand care and highlights their complexity. Possible solutions and policy changes that may help improve access have been described.
WenzingerERivera-BarriosAGonzalezG, et al. Trends in upper extremity injuries presenting to US emergency departments. Hand (N Y). 2019;14(3):408-412. doi:10.1177/1558944717735943.
2.
BaxterNBChungKC.Navigating the intersection of evidence and policy in hand surgery practice. Hand Clin. 2020;36(2):123-129. doi:10.1016/j.hcl.2020.01.001.
3.
BrownTSHinojosaLSClineKE, et al. Lack of acute hand care in the Southwest United States. J Orthop Trauma. 2016;30(4):e129-e131. doi:10.1097/BOT.0000000000000487.
4.
AlokozaiACrijnsTJJanssenSJ, et al. Cost in hand surgery: the patient perspective. J Hand Surg Am. 2019;44(11):992.e1-992.e26. doi:10.1016/j.jhsa.2019.01.009.
5.
CaffeeHRudnickC.Access to hand surgery emergency care. Ann Plast Surg. 2007;58(2):207-208.
6.
AldermanAKStoreyAFChungKC.Financial impact of emergency hand trauma on the health care system. J Am Coll Surg. 2008;206(2):233-238. doi:10.1016/j.jamcollsurg.2007.07.043.
7.
CalfeeRPShahCMCanhamCD, et al. The influence of insurance status on access to and utilization of a tertiary hand surgery referral center. J Bone Joint Surg Am. 2012;94(23):2177-2184. doi:10.2106/JBJS.J.01966.
8.
GiladiAMAliuOChungKC.The effect of Medicaid expansion on delivery of finger and thumb replantation care to Medicaid beneficiaries and the uninsured. Plast Reconstr Surg. 2015;136(5):640e-647e. doi:10.1097/PRS.0000000000001697.
9.
SearsEDChungKC.Future education and practice initiatives in hand surgery: improving fulfillment of patient needs. Hand Clin. 2014;30(3):377-386, vii-viii. doi:10.1016/j.hcl.2014.05.001.
10.
YuanFChungKC.Impact of safety net hospitals in the care of the hand-injured patient: a national perspective. Plast Reconstr Surg. 2016;138(2):429-434. doi:10.1097/PRS.0000000000002373.
11.
TriccoACLillieEZarinW, et al. PRISMA Extension for Scoping Reviews (PRISMA-ScR): checklist and explanation. Ann Intern Med. 2018;169(7):467-473.
12.
ArkseyHO’MalleyL.Scoping studies: towards a methodological framework. Int J Soc Res Methodol. 2005;8(1):19-32. doi:10.1080/1364557032000119616.
13.
EberlinKRHartzellTLKuoP, et al. Patients transferred for emergency upper extremity evaluation: does insurance status matter. Plast Reconstr Surg. 2013;131(3):593-600. doi:10.1097/PRS.0b013e31827c6e82.
14.
ButalaPFisherMDBlueschkeG, et al. Factors associated with transfer of hand injuries to a level 1 trauma center: a descriptive analysis of 1147 cases. Plast Reconstr Surg. 2014;133(4):842-848.
15.
PattersonJMBoyerMIRicciWM, et al. Hand trauma: a prospective evaluation of patients transferred to a level I trauma center. Am J Orthop (Belle Mead NJ). 2010;39(4):196-200.
16.
DroletBCTandonVJHaAY, et al. Unnecessary emergency transfers for evaluation by a plastic surgeon: a burden to patients and the health care system. Plast Reconstr Surg. 2016;137(6):1927-1933. doi:10.1097/PRS.0000000000002147.
17.
BilligJINasserJSChoHE, et al. Association of interfacility transfer and patient and hospital characteristics with thumb replantation after traumatic amputation. JAMA Network Open. 2021;4(2):e2036297. doi:10.1001/jamanetworkopen.2020.36297.
18.
DraegerRWPattersonBMOlssonEC, et al. The influence of patient insurance status on access to outpatient orthopedic care for flexor tendon lacerations. J Hand Surg Am. 2014;39(3):527-533. doi:10.1016/j.jhsa.2013.10.031.
19.
KrishnanJChungKC.Access to hand therapy following surgery in the United States: barriers and facilitators. Hand Clin. 2020;36(2):205-213. doi:10.1016/j.hcl.2020.01.006.
20.
ChoHEZhongLKotsisSV, et al. Finger Replantation Optimization Study (FRONT): update on national trends. J Hand Surg Am. 2018;43(10):903-912. doi:10.1016/j.jhsa.2018.07.021.
21.
LiNYKleinerJEHarrisAP, et al. Pediatric digit replantation following traumatic amputation: nationwide analysis of patient selection, outcomes, and cost. Hand (N Y). 2021;16(5):612-618. doi:10.1177/1558944719873150.
22.
MahmoudiEHuettemanHEChungKC.A population-based study of replantation after traumatic thumb amputation, 2007-2012. J Hand Surg Am. 2017;42(1):25-33. doi:10.1016/j.jhsa.2016.10.016.
23.
SquitieriLReichertHKimHM, et al. Patterns of surgical care and health disparities of treating pediatric finger amputation injuries in the United States. J Am Coll Surg. 2011;213(4):475-485. doi:10.1016/j.jamcollsurg.2011.07.017.
24.
EndorfFWNygaardRM.Socioeconomic and comorbid factors associated with frostbite injury in the United States. J Burn Care Res. 2022;43:646-651. doi:10.1093/jbcr/irab162.
25.
NygaardRMEndorfFW.Patterns of skin substitute use in isolated face and hand burns. Burns Open. 2017;1(2):63-66. doi:10.1016/j.burnso.2017.07.003.
26.
MahmoudiESwiatekPRChungKC.Emergency department wait time and treatment of traumatic digit amputation: do race and insurance matter. Plast Reconstr Surg. 2017;139(2):444e-454e. doi:10.1097/PRS.0000000000002936.
27.
ZubovicEVan HandelACSkolnickGB, et al. Insurance status and disparities in outpatient care after traumatic injuries of the hand: a retrospective cohort study. Plast Reconstr Surg. 2021;147(3):545-554. doi:10.1097/PRS.0000000000007687.
28.
ZhongLChungKCBaserO, et al. Variation in rheumatoid hand and wrist surgery among Medicare beneficiaries: a population-based cohort study. J Rheumatol. 2015;42(3):429-436. doi:10.3899/jrheum.140658.
29.
LongCSuarezPAHernandez-BoussardT, et al. Disparities in access to care following traumatic digit amputation. Hand (N Y). 2020;15(4):480-487. doi:10.1177/1558944718824700.
30.
Rios-DiazAJMetcalfeDSinghM, et al. Inequalities in specialist hand surgeon distribution across the United States. Plast Reconstr Surg. 2016;137(5):1516-1522. doi:10.1097/PRS.0000000000002103.
31.
ElbulukAMMiloneMTCapoJT, et al. Trends and demographics in the utilization of total wrist arthroplasty. J Hand Surg Asian Pac Vol. 2018;23(4):501-505. doi:10.1142/S2424835518500492.
32.
ViradiaRAnnieFHKaliM, et al. Hand injuries of coal miners in Southern West Virginia: a pilot study on health-care resources in Southern West Virginia. J Emerg Trauma Shock. 2021;14(1):18-22. doi:10.4103/JETS.JETS_39_19.
33.
DayCSAlexanderMLalS, et al. Effects of workers’ compensation on the diagnosis and surgical treatment of patients with hand and wrist disorders. J Bone Joint Surg Am. 2010;92(13):2294-2299. doi:10.2106/JBJS.I.00158.
34.
RooksHJAnthonyJRSextonKW, et al. Transfers for hand surgery correlate with increased reoperations for complications. Am Surg. 2015;81(11):1177-1181.
35.
LongCChoBHGiladiAM.Understanding surprise out-of-network billing in hand and upper extremity care. J Hand Surg Am. 2021;46(3):236-240. doi:10.1016/j.jhsa.2020.11.008.
36.
EberlinKRPayneDESMcCollamSM, et al. Hand trauma network in the United States: ASSH member perspective over the last decade. J Hand Surg Am. 2021;46(8):645-652. doi:10.1016/j.jhsa.2021.03.018.
37.
MuellerMAZaydfudimVSextonKW, et al. Lack of emergency hand surgery: discrepancy between elective and emergency hand care. Ann Plast Surg. 2012;68(5):513-517. doi:10.1097/SAP.0b013e31823b6a35.
38.
WhippleLAKellyTAliuO, et al. The crisis of deficiency in emergency coverage for hand and facial trauma: exploring the discrepancy between availability of elective and emergency surgical coverage. Ann Plast Surg. 2017;79(4):354-358. doi:10.1097/SAP.0000000000001155.
39.
PotiniVCBratchenkoWJacobG, et al. Repeat emergency room visits for hand and wrist injuries. J Hand Surg Am. 2014;39(4):752-756. doi:10.1016/j.jhsa.2014.01.019.
40.
TadrosASharonMChillN, et al. Emergency department visits for work-related injuries. Am J Emerg Med. 2018;36(8):1455-1458. doi:10.1016/j.ajem.2018.04.058.
41.
MalikATKhanSNGoyalKS.Declining trend in Medicare physician reimbursements for hand surgery from 2002 to 2018. J Hand Surg Am. 2020;45(11):1003-1011. doi:10.1016/j.jhsa.2020.08.010.
42.
MeyerFN. Commentary on “the influence of patient insurance status on access to outpatient orthopedic care for flexor tendon lacerations.”J Hand Surg Am. 2014;39(3):534. doi:10.1016/j.jhsa.2013.11.028.
43.
HooperRCSterbenzJMZhongL, et al. An in-depth review of physician reimbursement for digit and thumb replantation. J Hand Surg Am. 2019;44(6):443-453. doi:10.1016/j.jhsa.2019.02.019.
44.
ChanDSPodeszwaDABrownD, et al. Expanding pediatric orthopaedic trauma volume at a pediatric level 1 trauma hospital. J Pediatr Orthop. 2009;29(6):612-617. doi:10.1097/BPO.0b013e3181b29dc4.
45.
PalmKBBlazarPEMannaJC, et al. Feasibility, effectiveness and patient satisfaction of telerehabilitation after thumb carpometacarpal arthroplasty and reverse total shoulder arthroplasty: a pilot study [published online ahead of print March 5, 2021]. J Telemed Telecare. doi:10.1177/1357633X21999578.
46.
WorboysTBrassingtonMWardEC, et al. Delivering occupational therapy hand assessment and treatment sessions via telehealth. J Telemed Telecare. 2018;24(3):185-192. doi:10.1177/1357633X17691861.
47.
KhansaIKhansaLPearsonGD, et al. Effects of the Affordable Care Act on payer mix and physician reimbursement in hand surgery. J Hand Surg Am. 2018;43(6):511-515. doi:10.1016/j.jhsa.2018.02.032.
48.
JacksonKRNixonATPollinsA, et al. An evaluation of emergency hand coverage in Tennessee after implementation of the Affordable Care Act. Ann Plast Surg. 2019;83(1):40-42. doi:10.1097/SAP.0000000000001912.
49.
EarpBELouieDBlazarP.The impact of Massachusetts health care reform on an orthopedic hand service. J Hand Surg Am. 2013;38(11):2212-2217. doi:10.1016/j.jhsa.2013.04.041.
50.
GittingsDJMendenhallSDLevinLS.A decade of progress toward establishing regional hand trauma centers in the United States. Hand Clin. 2019;35(2):103-108. doi:10.1016/j.hcl.2018.12.001.
51.
AzourySCZapolskyIWinkJ, et al. Making upper extremity microvascular trauma care available 24/7/365 in the US: the first report out of the National Hand Trauma Center Network. J Am Coll Surg. 2020;231(4)(suppl 2):e172. doi:10.1016/j.jamcollsurg.2020.08.454.
Supplementary Material
Please find the following supplemental material available below.
For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.
For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.
