These are great points - nice discussion! We are interested in both safety
and mobility topics and improving the coordination and quality of NEMT.
A colleague at Virginia DOT and I are interested in pursuing funding for a
renal transportation project. Aside from NCHRP - are there any
recommendations about who might be interested in funding that topic?
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Today's Topics:
1. Transportation barriers, health care access and outcomes
(Hank Weiss)
2. Re: Transportation barriers, health care access and outcomes
(Sheryl Gross-Glaser)
----------------------------------------------------------------------
Message: 1
Date: Sun, 2 Mar 2014 19:44:58 +0000
From: Hank Weiss <hank.weiss(a)otago.ac.nz>
Subject: [H+T--Friends] Transportation barriers, health care access
and outcomes
To: "h+t--friends(a)chrispy.net" <h+t--friends(a)chrispy.net>
Message-ID:
<
476E461795D56248AE22F244F76E36B41260109B(a)ITS-EXM-P05.registry.otago.ac.nz>
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Kara:
Thank you and Chris for sharing; this is great you are doing this work.
Several other aspects are worth mentioning.
The first is something I am sure some of the references discuss. Like the
way we have built much of our infrastructure, little attention is paid to
anything other than private motor vehicle access when planning health
facilities. This sometimes leads to a false dichotomy by "blaming" lack of
MV ownership/access as an important part of the problem. As people on this
list serve know, it's more complex than that. Encouraging more/cheaper car
use among people who cannot afford it is not the solution, especially when
car dependency may be part of the reason why such people are in need of
medical care in the first place! The many feedback loops and their
directions are not yet well elucidated. A telling exercise is to go the
public website of any hospital or clinic and look for walking, biking and
transit directions.
I would also suggest that such work not focus only on the sick patient and
transport for care. It is often someone else who makes the transport
decision. Further, the trips generated by inpatient illness episodes are
mostly by employees, suppliers, family and friends, not the patient. One
wonders if and how disparity in outcomes might be related to how difficult
it is for family and friend supporters to be part of the disease care and
recovery experience and the role accessibility plays.
The injury dimension of transport mode and health outcomes also should not
be neglected. There is a small separate literature that looks at the
safety of EMS and ambulances from a patient perspective. National data are
hard to come by, however. But ambulances and ambulance runs can be risky
endeavors. Look for the work by Dr Nadine Levick. This pertains to
non-ambulance trips as well. How many pregnant women and babies are injured
during the urgent private drive to the hospital? I doubt such episodes are
tracked and I doubt the risks of transport are ever calculated in cost
benefit analyses of medical care planning or providing in almost any
setting.
Lastly, I can't put my finger on it at the moment, but there was a flurry
of important work in this area during the 70's oil embargo for obvious
reasons. As private car use and access declines on a per capita basis, a
well-documented nine year trend*, the issues of transport and healthcare
access will become more and more important.
Hank Weiss
---------------------
*"Evidence suggests that the decline is likely due to changing
demographics, saturated highways, and a rising preference for compact,
mixed-use neighborhoods, which reduce the need for driving" .
http://www.ssti.us/2014/02/vmt-drops-ninth-year-dots-taking-notice/
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Message: 1
Date: Sat, 1 Mar 2014 10:41:00 -0800
From: "Kara E. MacLeod" <kara.e.m(a)gmail.com>
Subject: Re: [H+T--Friends] H+T--Friends Digest, Vol 35, Issue 1
To: h+t--friends(a)chrispy.net
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At UC Berkeley SafeTREC we are working on a Medicaid transportation study.
Here is some background from one of our recent publications with
references at the end.
Transportation barriers have been associated with poorer health care
access, differential treatment, missed or delayed medical appointments, and
lower health status (Fitzpatrick, Powe, Cooper, Ives, & Robbins, 2004;
Goodwin, Hunt, & Samet, 1993; Gwira et al., 2006; Horton & Johnson, 2010;
Okoro, Strine, Young, Balluz, & Mokdad, 2005; Rittner & Kirk, 1995).
Transportation has been recognized as a key ele- ment of health care
access, which highlights its role to offset long-term health consequences.
Delayed medical care may adversely affect patients' quality of life and
result in more depressive symptoms (Owsley et al., 2007). These delays can
also lead to an increased need for emergency care and pre- ventable
hospitalizations and result in higher medical costs (Hughes-Cromwich &
Wallace, 2006; Rust et al., 2008).
Approximately 3.6 million adults miss or delay non- emergency medical care
due to transportation barriers (Hughes-Cromwich & Wallace, 2006). The
population missing these visits may be particularly susceptible to poorer
health status and higher cost of care. These transpor- tation barriers are
more likely to influence older individu- als, females, minorities, and
those with lower income levels (Hughes-Cromwich & Wallace, 2006; U.S.
Government Accountability Office, 2003). Medicaid acknowledges the
importance of transportation for vulnerable populations and the associated
potential costs of delayed medical care (Kim, Norton, & Stearns, 2009). In
fact, federal Medicaid requires that states "ensure necessary
transportation for recipients to and from providers" to help meet the needs
of this population and the intent of Medicaid (The Hilltop Institute, 2008
).
Bellamy,G. R., Stone,K., Richardson,S. K., & Goldsteen,R. L. (2003).
Getting from here to there: Evaluating West Virginia's rural nonemergency
medical transportation program. Journal of Rural Health, 19(Suppl), 397-406.
Community Transportation Association of America. (2008). Federal Register,
73, 245.
http://web1.ctaa.org/webmodules/webarticles/
articlefiles/cms1219.pdf<http://web1.ctaa.org/webmodules/webarticles/art…
<http://web1.ctaa.org/webmodules/webarticles/articlefiles/cms1219.pdf>
.
Community Transportation Association of America. (2009). America's
Affordable Health Choices Act of 2009. http://
www.ctaa.org/webmodules/webarticles/articlefiles/AAHCA_
BillText_071409.pdf<http://www.ctaa.org/webmodules/webarticles/articlefi…
<
http://www.ctaa.org/webmodules/webarticles/articlefiles/AAHCA_BillText_0714…
.
Community Transportation Association of America. (2010). An overview: How
health care reform impacts community and public transportation.
http://web1.ctaa.org/webmodules/webar-
ticles/anmviewer.asp?a=1672&z=5<
http://web1.ctaa.org/webmodules/webar-ticles/anmviewer.asp?a=1672&z=5&g…z=5>.
Fitzpatrick,A. L., Powe,N. R., Cooper,L. S., Ives,D. G., & Robbins,J. A.
(2004). Barriers to health care access among the elderly and who perceives
them. American Journal of Public Health, 94, 1788-1794.
http://dx.doi.org/10.2105/AJPH.94.10.1788.
Goodwin,J. S., Hunt,W. C., & Samet,J. M. (1993). Determinants of cancer
therapy in elderly patients. Cancer, 72, 594-601.
Gwira,J. A., Vistamehr,S., Shelsta,H., Bashford,K., Forster,S.,
Palmisano,P., Shafranov,G., & Shields,M. B. (2006). Factors associated with
failure to follow up after glaucoma screening: a study in an African
American population. Ophthalmology, 113, 1315-1319.
http://dx.doi.org/10.1016/j.ophtha.2006.04.017
Horton,S., & Johnson,R. J. (2010). Improving access to health care for
uninsured elderly patients. Public Health Nursing, 27, 362- 370.
doi:10.1111/j.1525-1446.2010.00866.x
Hughes-Cromwich,P. & Wallace,R. (2006). Cost benefit analy- sis of
providing non-emergency medical transportation. Transportation Research
Record: Journal of the Transportation Research Board, 1956, 86-93.
doi:10.3141/1956-11
Kim,J., Norton,E. C., & Stearns,S. C. (2009). Transportation brokerage
services and Medicaid beneficiaries' access to care. Health Services
Research, 44, 145-161. doi:10.1111/j.1475-6773.2008.00907.x
Leduc,N., Tannenbaum,T. N., Bergman,H., Champagne,F., Clarfield,A. M., &
Kogan,S. (1998). Compliance of frail elderly with health services
prescribed at discharge from an acute-care geriatric ward. Medical Care,
36, 904-914. doi:10.1097/00005650-199806000-00013
Leutz,W., & Capitman,J. (2007). Met needs and unmet needs, and
satisfaction among Social HMO members. Journal of Aging & Social Policy,
19, 1-19.
doi:10.1300/J031v19n01_01
Lynott,J., Fox-Grage,W., & Guzman,S. (2013). Weaving it together: A
tapestry of transportation funding for older adults. AARP Public Policy
Institute.
http://www.aarp.org/research/ppi/liv-
com2/policy/transportation/articles/weaving-it-together-trans-<http://ww…
portation-funding-for-older-adults-AARP-ppi-liv-com.html<
http://www.aarp.org/research/ppi/liv-com2/policy/transportation/articles/we…
Nasvadi,G. E. & Wister,A. V. (2006). Informal social support and use of a
specialized transportation system by chronically ill older adults.
Environment and Behavior, 38, 209-225. doi:10.1177/0013916505277605
Owsley,C., McGwin,G. Jr, Scilley,K., Meek,G. C., Seker,D., & Dyer,A.
(2007). Effect of refractive error correction on health-related quality of
life and depression in older nursing home residents. Archives of
Ophthalmology, 125, 1471-1477. doi:10.1001/ archopht.125.11.1471
Rittner,B., & Kirk,A. B. (1995). Health care and public transpor- tation
use by poor and frail elderly people. Social Work, 40, 365-373.
http://search.proquest.com/docview/1297015299?acc
ountid=14496 <
http://search.proquest.com/docview/1297015299?accountid=14496>
Rust,G., Ye,J., Baltrus,P., Daniels,E., Adesunloye,B., & Fryer,G. E.
(2008). Practical barriers to timely primary care access: Impact on adult
use of emergency department services. Archives of Internal Medicine, 168,
1705-1710. doi:10.1001/ archinte.168.15.1705
The Hilltop Institute. (2008). Non-Emergency Medical Transportation (NEMT)
Study Report.
http://www.hilltopinsti-
tute.org/publications/Non-EmergencyMedicalTransportationSt
udyReport-September2008.pdf<http://tute.org/publications/Non-EmergencyMe…
<
http://tute.org/publications/Non-EmergencyMedicalTransportationStudyReport-…
.
Whittier,S., Scharlach,A. E., & Dal Santo,T. S. (2005). Availability of
caregiver support services: Implications for implementation of the National
Family Caregiver Support Program. Journal of Aging and Social Policy, 17,
45-62. doi:10.1300/J031v17n01_03
Yeatts,D. E., Crow,T., & Folts,E. (1992). Service use among low- income
minority elderly: Strategies for overcoming barriers. The Gerontologist,
32, 24-32. doi:10.1093/geront/32.1.24
On Sat, Mar 1, 2014 at 10:00 AM, <h+t--friends-request(a)chrispy.net> wrote:
> Today's Topics:
> 1. Access to Health Care (Ed
Christopher)
> 2. Re: Access to Health Care (Rajiv Bhatia)
> 3. Re: Access to Health Care (denita Jones)
> 4. Re: Access to Health Care (Rajiv Bhatia)
> ----------------------------------------------------------------------
> Message: 1
> Date: Fri, 28 Feb 2014 14:43:16 -0600
> From: Ed Christopher <edc(a)berwyned.com>
> Subject: [H+T--Friends] Access to Health Care
> To: TRB Health and Transportation <h+t--friends(a)chrispy.net>
> Message-ID: <5310F4E4.9060008(a)berwyned.com>
> Content-Type: text/plain; charset=ISO-8859-1; format=flowed
> I got asked a question today, from a
transportation perspective, about
> access to health care and health facilities. As I started to hunt
> around on the web I thought I would throw it out to our Listserve.
> Does anyone know of any research, literature or other articles that
> they could pass along dealing with access to health care services?
> Thanks
> --
> Ed Christopher
> ------------------------------
> Message: 2
> Date: Fri, 28 Feb 2014 13:13:39 -0800
> From: Rajiv Bhatia <rb6419(a)gmail.com>
> Subject: Re: [H+T--Friends] Access to Health Care
> To: TRB Health and Transportation <h+t--friends(a)chrispy.net>
> Message-ID: <73BF7334-5E7C-4BC7-8B00-1C6139B8B486(a)gmail.com>
> Content-Type: text/plain; charset=us-ascii
> There is limited information on this
topic. I did a review of this
> and other EJ impacts for EPA a few years ago.
> A few studies have looked at
transport access to facilities and their
> association to health outcomes. Most studies treated the "exposure
> variable" as auto ownership. Net conclusion is that auto owners have
> better access to health facilities. THere is a very limited association
> to health outcomes.
> I would not take this as a null
result -- just one that has been
> understudied.
> Rajiv
> On Feb 28, 2014, at 12:43 PM,
Ed Christopher <edc(a)berwyned.com> wrote:
> > I got asked a question today,
from a transportation perspective,
> > about access to health care and health facilities. As I started to
> > hunt around on the web I thought I would throw it out to our
> > Listserve. Does anyone know of any research, literature or other
> > articles that they could pass along dealing with access to health care
services?
>
> > Thanks
> > --
> > Ed Christopher
> > _______________________________________________
> > H+T--Friends mailing list
> > H+T--Friends(a)chrispy.net
> >
https://www.chrispy.net/mailman/listinfo/h+t--friends
> ------------------------------
> Message: 3
> Date: Fri, 28 Feb 2014 15:12:18 -0600
> From: denita Jones <denita944(a)gmail.com>
> Subject: Re: [H+T--Friends] Access to Health Care
> To: TRB Health and Transportation <h+t--friends(a)chrispy.net>
> Message-ID:
> <CAKZGZAxDq9_5x+JQrc_Z3oL5oFe5yYaE4zKh=
> 5vJ7_jHgdNnmA(a)mail.gmail.com>
> Content-Type: text/plain; charset="iso-8859-1"
> Im actually presenting research in
that area in DC next month. I'm not
> in a position now to give the names of articles (im driving) But I can
> send them to you and suggest sites.
> On Feb 28, 2014 3:07 PM, "Ed Christopher" <edc(a)berwyned.com> wrote:
> > I got asked a question today,
from a transportation perspective,
> > about access to health care and health facilities. As I started to
> > hunt around on the web I thought I would throw it out to our
> > Listserve. Does anyone know of any research, literature or other
> > articles that they could pass along dealing with access to health care
services?
>
> > Thanks
> > --
> > Ed Christopher
> > _______________________________________________
> > H+T--Friends mailing list
> > H+T--Friends(a)chrispy.net
> >
https://www.chrispy.net/mailman/listinfo/h+t--friends
>
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> ------------------------------
> Message: 4
> Date: Fri, 28 Feb 2014 18:58:16 -0800
> From: Rajiv Bhatia <rb6419(a)gmail.com>
> Subject: Re: [H+T--Friends] Access to Health Care
> To: TRB Health and Transportation <h+t--friends(a)chrispy.net>
> Message-ID: <B6368ACB-B234-45D2-87FB-80F7D05E9F54(a)gmail.com>
> Content-Type: text/plain; charset="us-ascii"
> Ed
> These are the studies I found in a
2009 review -- i'm sure there are
> new ones.
> 1. Ahmed SM, Lemkau JP,
Nealeigh N, and Mann B. Barriers
> to healthcare access in a non-elderly urban poor American population.
> Health and Social Care in the Community. 2001; 9:445-453.
> 2. Yang S, Zarr RL,
Kass-Hout TA, Kourosh A, Kelly NR.
> Transportation barriers to accessing health care for urban children.
> Journal of Health Care for the Poor and Underserved. 2006; 17:928-43.
> 3. Rust G, Ye J, Baltrus
P, Daniels E, Adesunloye B, Fryer
> GE. Practical barriers to timely primary care access: impact on adult
> use of emergency department services. Archives in Internal Medicine.
> 2008; 168:1705-1710.
> 4. Arcury TA, Preisser
JS, Gesler WM, Powers JM. Access to
> transportation and health care utilization in a rural region. Journal
> of Rural Health. 2005; 21:31-38.
> On Feb 28, 2014, at 12:43 PM,
Ed Christopher <edc(a)berwyned.com> wrote:
> > I got asked a question today,
from a transportation perspective,
> > about access to health care and health facilities. As I started to
> > hunt around on the web I thought I would throw it out to our
> > Listserve. Does anyone know of any research, literature or other
> > articles that they could pass along dealing with access to health care
services?
>
> > Thanks
> > --
> > Ed Christopher
> > _______________________________________________
> > H+T--Friends mailing list
> > H+T--Friends(a)chrispy.net
> >
https://www.chrispy.net/mailman/listinfo/h+t--friends
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