title: Tennessee emergency hand care distributions and disparities: Emergent hand care disparities.
abstract: 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 socioeconomic factors 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. Wilcoxon rank-sum test or permutation chi-square test and logistic regression were used to analyze reported measures.
  
  
  RESULTS
  Our results revealed that hospitals in counties with the lowest per capita income and median household income are less likely to have hand specialists or offer hand call. There are also significantly fewer hospitals that have hand specialists and offer hand call that are located in medically underserved areas. In the state of TN, level 1 trauma facilities are required by the Tennessee Department of Health to have staffed hand specialists and 24/7 hand call. Our study revealed that while 7/8 (87.5 %) level 1 trauma facilities have hand specialists, only 2/8 (25 %) provide 24/7 hand specialist call.
  
  
  CONCLUSIONS
  Our results strongly suggest the presence of a health care disparity for hand trauma in counties with a low income and in medically underserved areas.
authors.affiliation: School of Medicine, Meharry Medical College, 1005 Doctor D.B. Todd Junior Boulevard, Nashville, TN 37208 USA ; Department of Plastic Surgery, Vanderbilt University Medical Center, 1211 Medical Center Drive, Nashville, TN 37232 USA.
authors.forename: Joshua R
authors.initials: JR
authors.lastname: Anthony
authors.affiliation: Weldon School of Biomedical Engineering, Purdue University, 206 Martin Jischke Drive, West Lafayette, IN 47907 USA.
authors.forename: Victoria N
authors.initials: VN
authors.lastname: Poole
authors.affiliation: Department of Plastic Surgery, Vanderbilt University Medical Center, 1211 Medical Center Drive, Nashville, TN 37232 USA.
authors.forename: Kevin W
authors.initials: KW
authors.lastname: Sexton
authors.affiliation: Department of Biostatistics, Vanderbilt University School of Medicine, 2323 Medical Center North, Nashville, TN 37232-2158 USA.
authors.forename: Li
authors.initials: L
authors.lastname: Wang
authors.affiliation: Department of Plastic Surgery, Vanderbilt University Medical Center, 1211 Medical Center Drive, Nashville, TN 37232 USA ; School of Medicine, Vanderbilt University, 1161 21st Ave S # D3300, Nashville, TN 37232 USA.
authors.forename: Melissa A
authors.initials: MA
authors.lastname: Mueller
authors.affiliation: Division of Trauma and Surgical Critical Care, Vanderbilt University Medical Center, 1211 Medical Center Drive, Nashville, TN 37232 USA.
authors.forename: Oscar
authors.initials: O
authors.lastname: Guillamondegui
authors.affiliation: Department of Plastic Surgery, Vanderbilt University Medical Center, 1211 Medical Center Drive, Nashville, TN 37232 USA.
authors.forename: R Bruce
authors.initials: RB
authors.lastname: Shack
authors.affiliation: Department of Plastic Surgery, Vanderbilt University Medical Center, 1211 Medical Center Drive, Nashville, TN 37232 USA.
authors.forename: Wesley P
authors.initials: WP
authors.lastname: Thayer
keywords: Disparities; Disparity; Distributions; EMTALA; Elective; Emergency; Hand call; Hand specialist; Hand surgeon; Hand surgery; Income; Medically underserved area; Metropolitan; Rural; Tennessee; Trauma