Addressing Transportation Insecurity Improves Attendance at Posthospitalization Appointments

Abstract

BACKGROUND: Transportation influences attendance at posthospitalization appointments (PHAs). In 2017, our pediatric hospital medicine group found that our patients missed 38% of their scheduled PHAs, with several being due to transportation insecurity. To address this, we implemented a quality improvement project to perform inpatient assessment of transportation insecurity and provide mitigation with the goal of improving attendance at PHAs. METHODS: The process measure was the percentage of patients with completed transportation insecurity screening, and the outcome measure was PHA attendance. An interprofessional team performed plan-do-study-act cycles. These included educating staff about the significance of transportation insecurity, its assessment, and documentation; embedding a list of local transportation resources in discharge instructions and coaching families on using these resources; notifying primary care providers of families with transportation insecurity; and auditing PHA attendance. RESULTS: Between July 2018 and December 2019, electronic health record documentation of transportation insecurity assessment among patients on the pediatric hospital medicine service and discharged from the hospital (n = 1731) increased from 1% to 94%, families identified with transportation insecurity increased from 1.2% to 5%, and attendance at PHAs improved for all patients (62%–81%) and for those with transportation insecurity (0%–57%). Our balance measure, proportion of discharges by 2 pm, remained steady at 53%. Plan-do-study-act cycles revealed that emphasizing PHA importance, educating staff about transportation insecurity, and helping families identify and learn to use transportation resources all contributed to improvement. CONCLUSIONS: Interventions implemented during the inpatient stay to assess for and mitigate transportation insecurity led to improvement in pediatric PHA attendance.

Do patients want clinicians to ask about social needs and include this information in their medical record?

“…In addition, two trends suggest the value of direct elicitation of social needs information from patients. First, studies continue to show the value of eliciting social needs for outcomes important for patients, such as providing transportation to reduce missed medical appointments [14], providing housing to reduce COVID transmission [15], changing landlord behavior to reduce home health hazards [16], and using food prescriptions to address nutritional deficits [17]. Second, health care organizations and insurance plans are already acquiring social needs data by interrogating EHR records and geocoded public and proprietary databases.…”

A pilot study: the impact of clinic-provided transportation on missed clinic visits and system costs among teenage mother–child dyads

“…The Children's Health Fund in 2010 noted 4% of US children had missed healthcare appointments due to lack of transportation, which increased to 9% in households with an average annual income below $50,000 (Grant et al, 2014). Those findings are supported by more recent estimates of 5% from a single institution, which also demonstrating improved pediatric follow-up rates after addressing transportation insecurity in 2022 (Hoffman et al, 2022).…”