Missed or Delayed Medical Care Appointments by Older Users of Nonemergency Medical Transportation

MacLeod, Kara E.; Ragland, David R; Prohaska, Thomas R.; Smith, Matthew Lee; Irmiter, Cheryl; Satariano, William A.

doi:10.1093/geront/gnu002

Cited by 32 publications

(22 citation statements)

References 28 publications

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“…28, 29 A review of computerized records from a large NEMT broker covering 40 states demonstrated that the majority of NEMT users were elderly patients residing in ZIP codes predominantly populated by African Americans, and from rural regions plagued by poverty. 30 These populations are very similar to the ones demonstrated to be associated with less travel effort, and may explain the disparities in the utilization of high-volume hospitals for complex surgery. 27, 31 As states adapt to increasing Medicaid enrollment, multiple states including Iowa and Indiana have received waivers from Medicaid to restrict coverage of NEMT for beneficiaries.…”

Section: Discussionmentioning

confidence: 59%

Potential impact of a volume pledge on spatial access: A population-level analysis of patients undergoing pancreatectomy

Fong

Loehrer

Castillo

et al. 2017

Surgery

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Background A minimum-volume policy restricting hospitals not meeting the threshold from performing complex surgery may increase travel burden and decrease spatial access to surgery. We aim to identify vulnerable populations that would be sensitive to an added travel burden. Methods We performed a retrospective analysis of the California Office of Statewide Health Planning and Development database for patients undergoing pancreatectomy from 2005 to 2014. Number of hospitals bypassed was used as a metric for travel. Patients bypassing fewer hospitals were deemed to be more sensitive to an added travel burden. Results There were 13,374 patients who underwent a pancreatectomy, of which 2,368 (17.7%) were non-bypassers. On unadjusted analysis, patients >80 year old travelled less than their younger counterparts, bypassing a mean of 10.9 ± 9.5 hospitals compared to 14.2 ± 21.3 hospitals bypassed by the 35–49 year old age group (p<0.001). Racial minorities travelled less when compared to Non-Hispanic Whites (p<0.001). Patients identifying their payer status as self-pay (8.9 ± 15.6 hospitals bypassed) and Medicaid (10.1 ± 17.2 hospitals bypassed) also travelled less when compared to patients with private insurance (13.8 ± 20.4 hospitals bypassed, p<0.001). On multivariate analysis, advanced age, racial minority and patients with self-pay or Medicaid payer status were independently associated with increased sensitivity to an added travel burden. Conclusion In patients undergoing pancreatectomy, the elderly, racial minorities and patients with self-pay or Medicaid payer status were associated with an increased sensitivity to an added travel burden. This vulnerable cohort may be disproportionately affected by a minimum-volume policy.

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Section: Discussionmentioning

confidence: 59%

Potential impact of a volume pledge on spatial access: A population-level analysis of patients undergoing pancreatectomy

Fong

Loehrer

Castillo

et al. 2017

Surgery

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“…Given that transportation is among the highest reported needs for American older adults [9,69], the location of senior centers may indicate the need for transportation services among facility residents to ensure that they can access programs and resources offered at such entities. Facilities are encouraged to create partnerships with non-emergency medical transportation brokers as a strategy to increase mobility among older adults with limited travel options [70,71]. …”

Section: Discussionmentioning

confidence: 99%

Variation in Older Adult Characteristics by Residence Type and Use of Home- and Community-Based Services

Ewen

Washington

Emerson

et al. 2017

IJERPH

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Background: The majority of older adults prefer to remain in their homes, or to “age-in-place.” To accomplish this goal, many older adults will rely upon home- and community-based services (HCBS) for support. However, the availability and accessibility of HCBS may differ based on whether the older adult lives in the community or in a senior housing apartment facility. Methods: This paper reports findings from the Pathways to Life Quality study of residential change and stability among seniors in upstate New York. Data were analyzed from 663 older adults living in one of three housing types: service-rich facilities, service-poor facilities, and community-dwelling in single-family homes. A multinomial logistic regression model was used to examine factors associated with residence type. A linear regression model was fitted to examine factors associated with HCBS utilization. Results: When compared to community-dwelling older adults, those residing in service-rich and service-poor facilities were more likely to be older, report more activity limitations, and provide less instrumental assistance to others. Those in service-poor facilities were more likely to have poorer mental health and lower perceived purpose in life. The three leading HCBS utilized were senior centers (20%), homemaker services (19%), and transportation services (18%). More HCBS utilization was associated with participants who resided in service-poor housing, were older, were female, and had more activity limitations. More HCBS utilization was also associated with those who received instrumental support, had higher perceived purpose in life, and poorer mental health. Conclusions: Findings suggest that older adults’ residential environment is associated with their health status and HCBS utilization. Building upon the Person–Environment Fit theories, dedicated efforts are needed to introduce and expand upon existing HCBS available to facility residents to address physical and mental health needs as well as facilitate aging-in-place.

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“…In particular, our findings newly highlight the importance of the favor model in low-income communities. Previous quantitative research has shown that it is common for chronically ill people to obtain rides from others to attend healthcare appointments (e.g., [5,107]), we demonstrate its use for access to employment and grocery stores. Moreover, we show several forms of resource pooling which, though rare, have not yet been well-documented.…”

Section: Interpersonal Trust Care And/or Reciprocitymentioning

confidence: 58%

Getting There

Dillahunt

Veinot

2018

ACM Trans. Comput.-Hum. Interact.

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Advances in Information and Communication Technologies (ICTs) offer new opportunities for addressing transportation needs; however, past research suggests that opportunities are not equally shared by millions of low-income Americans. We draw from four empirical studies and two case studies to contribute descriptions of the 11 everyday transportation models currently used by residents of low-income and underserved communities to enhance their access to health-enhancing resources. These models fell into personal, private, public, and interpersonal categories. We contribute insights regarding the following barriers and facilitators associated with these models: (1) affordability; (2) individual capabilities; (3) interpersonal trust, care and/or reciprocity; (4) trust in technology; (5) service availability/eligibility; (6) spatial and temporal matches; (7) match between transportation mode and physical needs; (8) service reliability and quality; and (9) infrastructure access. To address these barriers and build on these facilitators, we contribute six supportive policy and design principles. Operationalizing these principles, we propose four new ICT-enhanced models: (1) smart jitneys; (2) generalized, favor-based models; (3) expanded resource pooling; and (4) transportation clubs. The focus of these models on socio-technical integration with current capabilities and resources holds promise for enhancing access to jobs, food, and health care for residents of low-income communities.

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Missed or Delayed Medical Care Appointments by Older Users of Nonemergency Medical Transportation

Abstract: The evolving American health care system may increase service availability. Additional policies can improve service accessibility and overcome utilization barriers.

Cited by 32 publications

References 28 publications

Potential impact of a volume pledge on spatial access: A population-level analysis of patients undergoing pancreatectomy

Potential impact of a volume pledge on spatial access: A population-level analysis of patients undergoing pancreatectomy

Variation in Older Adult Characteristics by Residence Type and Use of Home- and Community-Based Services

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