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/ -----Original Message----- From: h+t--friends-bounces(a)chrispy.net [mailto:h+t--friends-bounces@chrispy.net] On Behalf Of h+t--friends-request(a)chrispy.net Sent: Monday, March 03, 2014 7:00 AM ---------------------------------------------------------------------- Message: 1 Date: Sat, 1 Mar 2014 10:41:00 -0800 From: "Kara E. MacLeod" &lt;kara.e.m(a)gmail.com&gt; Subject: Re: [H+T--Friends] H+T--Friends Digest, Vol 35, Issue 1 To: h+t--friends(a)chrispy.net Message-ID: &lt;CAGT3rCB0kN8MT5hSkMRX20CMLVbtXn8aOTAanmdjo3cqRZAE=A(a)mail.gmail.com&gt; Content-Type: text/plain; charset="iso-8859-1" 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… . 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…df>. 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/weba…72&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- portation-funding-for-older-adults-AARP-ppi-liv-com.html<http://www.aarp… 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…df>. 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, &lt;h+t--friends-request(a)chrispy.net&gt; wrote: