By Jonathan Papp on 5/7/18 10:00 AM
Seemingly every article that discusses non-emergency medical transportation mentions this metric: 3.6 million Americans miss or delay medical appointments each year due to transportation barriers. It's a stat worth highlighting but not the only one that helps frame the issue of patients unable to get to and from their appointments. So, here are six (alternative) stats to help further illuminate the problem, which are organized in three themes below.
1) The problem also affects children, and is especially impactful on inner-city children
The Journal of Health Care For the Poor and Underserved reported the results of a cross-sectional study where 21% of inner-city families cited transportation barriers as being a reason for not bringing a child in for health care. And despite there being more access to public transportation in cities, one study reported that NYC inner-city patients who ride the bus to the doctor's office were twice as likely to miss appointments as patients who drove cars.
2) Transportation challenges for patients with chronic conditions correlate with poorer treatment adherence and negative health outcomes
Studies have shown that transportation is often a barrier to receiving recurring treatment — especially for ongoing care related to HIV, diabetes, dialysis and cancer.
One 2011 study surveyed HIV-positive women living in rural areas asking about challenges faced when attempting to access care. Thirty-three percent of patients cited physical problems that prevented travel to care — which was the most mentioned barrier to care within the survey.
Another study looked at post-discharge follow-up for urban, African American patients with diabetes. Although 95% indicated that they planned to use follow-up services, 50% of these diabetes patients anticipated encountering transportation barriers to keeping their appointments.
Similarly, a study on chemotherapy adherence and the factors that led to under-utilization of treatment showed that patients were significantly less likely to receive first line of chemotherapy if they lived in neighborhoods that had a higher percentage of households without any vehicle (6.46).
For chronic kidney disease care, transportation is also a barrier to treatment adherence, and a contributor to patients having a suboptimal treatment experience. In a 2014 study, it was estimated that hemodialysis patients missed an average of 7.1 treatment days per year due to myriad factors, with transportation being one of the leading causes of missed appointments. Especially noteworthy, patients who traveled to dialysis via a transportation van were at an increased risk to forego their hemodialysis. As a result, these patients were hospitalized at a higher rate — and the study went on to estimate that efforts to improve transportation to dialysis could decrease unexpected hospitalizations by 0.8 days per patient-year.
3) NEMT is about more than ordering a ride. It's about matching patients with the right vehicles based on their needs
A recent analysis looked retrospectively at nearly 40,000 NEMT rides in Delaware and found that more than 21% of round-trip patients required a specialized vehicle (e.g. wheelchair van or stretcher ride). This underscores the point that health systems need to consider the unique physical needs of the individuals who are ordering rides, and provide specialized vehicles for those patients with physical barriers to conventional transportation.
Overall, the above findings only scratch the surface of the large amount of research that's taken place on transportation as a social determinant of health.
Here at Circulation, we're looking to break down those transportation barriers by bringing convenient, reliable, on-demand ride options to patients. More on that to come in subsequent posts.
Jon is Circulation's Director of Marketing.