Evaluating Associations Between Health Equity and High-Quality Care in Hand and Upper-Extremity Care: A Systematic Review.

PURPOSE: Timely and high-quality hand and upper-extremity care should be accessible to all patients. Certain demographic factors like age and body mass index have been consistently linked to differences in care, yet the influence of the social determinants of health (SDOH) remains a growing area of research. This study uses the three-delays model to evaluate associations between health inequities, as measured by the PROGnosis RESearch Strategy (PROGRESS) framework, and access to timely and high-quality hand and upper-extremity care.

METHODS: A systematic review of PubMed, EMBASE, and Web of Science was conducted using terms describing SDOH in hand and upper-extremity care. Studies were categorized based on the health inequity focus of the PROGRESS framework. The three-delays model was then used to assess how each PROGRESS factor contributed to suboptimal access, delivery, or receipt of hand and upper-extremity care. Descriptive statistics were used to report data.

RESULTS: Our initial search yielded 2587 articles, 75 of which were included. The most common pathologies studied were distal radius fractures (20 studies), general elective upper-extremity surgery (15 studies), and upper-extremity trauma (6 studies). Socioeconomic status was the most common health inequity-contributing factor studied (44 studies), followed by place of residence (24 studies) and gender/sex (24 studies). Within socioeconomic status, the most common factor studied was insurance status (24 studies), which was associated with all three delays. The most common delay studied was related to delay 3 (delays in receiving adequate care [51 studies]), followed by delay 2 (delays in reaching care [20 studies]) and delay 1 (delays in deciding to seek care [12 studies]).

CONCLUSIONS: Numerous SDOH-related factors have been correlated to access to timely and high-quality hand and upper-extremity care. In this study, we highlight the largely economic disparities in receipt of care and highlight opportunities for further research. With this analysis, we identify areas for intervention with the goal of providing equitable opportunities for patients to seek, access, and receive care.

TYPE OF STUDY/LEVEL OF EVIDENCE: Economic/decision analysis II.