Nonemergency Medical Transportation and Health Care Visits among Chronically Ill Urban and Rural Medicaid Beneficiaries

Thomas, Leela; Wedel, Kenneth R.

doi:10.1080/19371918.2013.865292

Cited by 18 publications

(19 citation statements)

References 6 publications

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“…Medicaid provides NEMT services in the form of direct delivery or public transit voucher programs to facilitate access to care for low-income beneficiaries who otherwise may not have a reliable and affordable means of getting to health care appointments, including patients with both Medicare and Medicaid coverage. 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.…”

Section: Discussionmentioning

confidence: 99%

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: 99%

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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“…A 2005 report by the Transportation Research Board of the National Academies found that 3.6 million Americans delay or miss medical care due to a transportation barrier each year [4]. Transportation is an important social determinant of health, acting as a facilitator or barrier to health self-management [5,6]. Known factors that influence access to transportation include socioeconomic status, ethnicity, geography (i.e., urban vs. rural), age, mode and type of travel, and distance or time burden [7].…”

Section: Introductionmentioning

confidence: 99%

“…Known factors that influence access to transportation include socioeconomic status, ethnicity, geography (i.e., urban vs. rural), age, mode and type of travel, and distance or time burden [7]. Inaccessibility to health care due to lack of transportation affects the most vulnerable groups of society such as low-income inner-city residents who often belong to racial/ethnic minority communities [6,8]. Multiple nationally-representative datasets have revealed that patients in ethnic minority groups were less likely to obtain medical care due to transportation barriers, controlling for socioeconomic status, and that patients who were White generally had increased access over those identifying as non-White [7], suggesting that transportation options are limited in minority communities.…”

Section: Introductionmentioning

confidence: 99%

A Systematic Review of Interventions to Minimize Transportation Barriers Among People with Chronic Diseases

et al. 2018

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Transportation is an important social determinant of health. Transportation barriers disproportionately affect the most vulnerable groups of society who carry the highest burden of chronic diseases; therefore, it is critical to identify interventions that improve access to transportation. We synthesized evidence concerning the types and impact of interventions that address transportation to chronic care management. A systematic literature search of peer-reviewed studies that include an intervention with a transportation component was performed using three electronic databases-PubMed, EMBASE, and CINAHL-along with a hand-search. We screened 478 unique titles and abstracts. Two reviewers independently evaluated 41 full-text articles and 10 studies met eligibility criteria for inclusion. The transportation interventions included one or more of the following: providing bus passes (n = 5), taxi/transport vouchers or reimbursement (n = 3), arranging or connecting participants to transportation (n = 2), and a free shuttle service (n = 1). Transportation support was offered within multi-component interventions including counseling, care coordination, education, financial incentives, motivational interviewing, and navigation assistance. Community health/outreach workers (n = 3), nurses (n = 3), and research or clinic staff (n = 3) were the most common interventionists. Studies reported improvements in cancer screening rates, chronic disease management, hospital utilization, linkage and follow up to care, and maternal empathy. Overall, transportation is a well-documented barrier to engaging in chronic care among vulnerable populations. We found evidence suggesting transportation services offered in combination with other tailored services improves patient health outcomes; however, future research is warranted to examine the separate impact of transportation interventions that are tested within multi-component studies.

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“…NEMT is used predominantly by individuals with chronic illnesses [14]. NEMT users, compared to those who do not use NEMT, are more likely to attend clinic appointments for their chronic conditions [16]. NEMT use has been shown to improve access to health services for children with asthma and adults with diabetes [17].…”

Section: Original Articlementioning

confidence: 99%

Challenges Faced by Latino Caregivers in Transportation of Children with Medical Complexity

Nageswaran¹,

Rosado²,

Beveridge³

2018

North Carolina Medical Journal

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background Transportation challenges affect access to health care. Our objective was to describe transportation challenges faced by Latino children with medical complexity and identify strategies that could address these challenges. methods This is a qualitative study. Seventy Latino children with medical complexity who were enrolled in a complex care program of a tertiary care children's hospital were followed for a median duration of 18 months. Qualitative data were care coordination notes for each child obtained from care coordinators' encounter logs and reported experiences. Using thematic content analysis and an iterative process, we identified recurrent themes related to transportation challenges. results Caregivers of Latino children with medical complexity face many challenges transporting their children to medical appointments. These include lack of vehicle, inability to drive, lack of driver's license due to immigration status, and lack of resources to maintain a vehicle. As a result, Latino children with medical complexity often need non-emergency medical transportation, but caregivers find these systems difficult to use, in part because of language difficulties. Thus, they rely on care coordinators to access non-emergency medical transportation. Transportation problems can lead to missed medical appointments for the child and lost work for the caregiver. We identified interrelated factors that contributed to transportation issues for Latino children with medical complexity and potential strategies to address them. limitations The extent of transportation challenges cannot be discerned because this is a qualitative study. conclusions Transportation is difficult for Latino children with medical complexity, who rely on non-emergency medical transportation to access medical services. Care coordinators play a major role in addressing transportation problems for Latino children with medical complexity and their caregivers.

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Nonemergency Medical Transportation and Health Care Visits among Chronically Ill Urban and Rural Medicaid Beneficiaries

Cited by 18 publications

References 6 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

A Systematic Review of Interventions to Minimize Transportation Barriers Among People with Chronic Diseases

Challenges Faced by Latino Caregivers in Transportation of Children with Medical Complexity

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