PURPOSE: Hand trauma is a challenge to triage and manage, especially in rural states, because of the relative paucity of fellowship-trained hand surgeons and equipped treatment centers. Since the establishment of the Arkansas Hand Trauma Telemedicine Program (AHTTP) in 2014, early data suggest a successful reduction in hospital transfers for hand trauma. The purpose of this economic and decision analysis study was to perform a comprehensive, longer-term analysis describing trends in emergency medical service (EMS) transfer rate for hand trauma in Arkansas in relation to the establishment of AHTTP. Secondary end points included estimated health care cost savings and geographic distribution of consults. METHODS: Data from all AHTTP encounters were used to conduct trend analyses in program utilization and interfacility transfers from 2013 to 2023. Cost savings were estimated based on Arkansas Medicare fee schedules. Consult origins were mapped to observe geographic distribution. RESULTS: The AHTTP facilitated 7, 260 remote hand trauma consults in its first decade. The rate of EMS ground transfer for consults placed via the AHTTP considerably decreased from 44. 9% to 33. 2% during the study period and as low as 28. 8% in 2022. Transfer rates were markedly lower compared with prior to the system's inception when the EMS transfer rate for hand trauma was 72. 6%. The incidence of air ambulance fell from a maximum of 31 in 2016 to three in 2021. An estimated 2, 519 EMS ground and 156 EMS air transfers were saved, roughly correlating to a cost savings of 12, 200, 000. A geographically diverse distribution of consults was observed. CONCLUSIONS: The AHTTP has notably decreased the overall rate of transfer for management of hand trauma across Arkansas, including EMS ground and air transfer, saving patients and taxpayers an estimated 12. 2M and increasing availability of local emergency medical resources. TYPE OF STUDY/LEVEL OF EVIDENCE: Economic and decision analysis, IV.
Montoya et al. (Sat,) studied this question.