Do Americans Lacking a Local Orthopaedic Surgeon Have Adequate Broadband for Telehealth?

Abstract

Background Although telehealth holds promise in expanding access to orthopaedic surgical care, high-speed internet connectivity remains a major limiting factor for many communities. Despite persistent federal efforts to study and address the health information technology needs of patients, there is limited information regarding the current high-speed internet landscape as it relates to access to orthopaedic surgical care. Questions/purposes (1) What is the distribution of practicing orthopaedic surgeons in the United States relative to the presence of broadband internet access? (2) What geographic, demographic, and socioeconomic factors are associated with the absence of high-speed internet and access to a local orthopaedic surgeon? Methods The Federal Communications Commission (FCC) Mapping Broadband in America interactive tool was used to determine the proportion of county residents with access to broadband-speed internet for all 3141 US counties. Data regarding the geographic distribution of orthopaedic surgeons and county-level characteristics were obtained from the 2015 Physician Compare National Downloadable File and the Area Health Resource File, respectively. The FCC mapping broadband public use files are considered the most comprehensive datasets describing high-speed internet infrastructure within the United States. The year 2015 represents the most recently available FCC data for which county-level broadband penetration estimates are available. Third-party audits of the FCC data have shown that broadband expansion has been slow over the past decade and that many large improvements have been driven by changes in the reporting methodology. Therefore, we believe the 2015 FCC data still hold relevance. The primary outcome measure was the simultaneous absence of at least 50% broadband penetration and at least one orthopaedic surgeon practicing in county limits. Statistical analyses using Kruskal-Wallis tests and multivariable logistic regression were conducted to assess for factors associated with inaccessibility to orthopaedic telehealth. All statistical tests were two-sided with a significance threshold of p < 0.05. Results In 2015, 14% (448 of 3141) of counties were considered "low access" in that they both had no orthopaedic surgeons and possessed less than 50% broadband access. A total of 4,660,559 people lived within these low-One of the authors (AFK) certifies receipt of payments or benefits, during the study period, in an amount of USD 10,000 to USD 100,000 from DePuy, in an amount of USD 10,000 to USD 100,000 from Zimmer Biomet, in an amount less than USD 10,000 from Innomed, in an amount less than USD 10,000 from Proctor and Gamble, and in an amount less than USD 10,000 from Signature Orthopaedics. All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research® editors and board members are on file with the publication and can be viewed on request. This study was exempt from ethical review board approval.

CORR Insights®: Do Americans Lacking a Local Orthopaedic Surgeon Have Adequate Broadband for Telehealth?

“…In a study by Jella et al [4] in this month’s Clinical Orthopaedics and Related Research ® , the authors used the Federal Communications Commission Mapping Broadband in America interactive tool to investigate the presence of broadband internet access regarding the distribution of practicing orthopaedic surgeons in the United States, as well as the geographic, demographic, and socioeconomic factors associated with the absence of high-speed internet and access to a local orthopaedic surgeon. Interestingly, the authors found that 14% of United States counties were considered “low-access” areas, meaning that the counties had no local orthopaedic surgeon and fewer than 50% of residents had broadband access.…”

“…This heatmap represents broadband internet access across the 1021 United States counties without access to a local orthopaedic surgeon. Reprinted with permission from Jella et al [4]. …”

“…The current study [4] provides an initial platform on which others can build. By highlighting the extent and locations of low-access regions, the authors have provided the impetus and guiding directions for practice groups and clinician scientists to take some much-needed next steps that could improve the health of our patients.…”