Association of Rideshare-Based Transportation Services and Missed Primary Care Appointments A Clinical Trial
Association of Rideshare-Based Transportation Services and Missed Primary Care Appointments A Clinical Trial
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DOI：
10.1001/jamainternmed.2017.8336
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发表时间：
2018-03-01
影响因子：
39
通讯作者：
Grande, David
中科院分区：
文献类型：
--
作者：
Chaiyachati, Krisda H.;Hubbard, Rebecca A.;Grande, David
重要性交通障碍导致医疗补助患者错过了初级保健预约。拼车服务已被提出作为替代非紧急医疗运输programmes.ObjectiveTo评估基于拼车的医疗运输和错过的初级保健预约之间的关联医疗补助patients.DESIGN，设置。在一项前瞻性临床试验中，纳入了786名居住在费城西部的医疗补助受益人，他们是同一建筑内2个学术内科实践中的1个的初级保健患者。参与者被分配到免费乘车共享服务（干预组）或常规护理（对照组），根据他们的初级保健预约提醒的预定日期。那些安排在偶数工作日的人在干预组，奇数工作日的人在对照组。主要研究结果是失约率，使用意向治疗方法估计。所有收到电话提醒的人都被纳入研究样本，无论他们是否接电话。该研究于2016年10月24日至2017年4月20日进行。干预设计了一种提供基于拼车的交通模式。作为常规护理的一部分，分配到两组的患者都会收到自动预约电话提醒。作为研究方案的一部分，分配至两组的患者在计划预约前2天收到研究人员最多3次额外的预约提醒电话。在这些电话中，干预组的患者获得了免费的乘车服务。研究人员为那些对这项服务感兴趣的人提供了游乐设施。预约后，患者打电话给研究人员开始回程home.Main结果和措施错过预约率（没有显示和当天取消）在干预相比，对照arm.Results的786例患者分配到干预或对照组，566（72.0%）是女性，平均（SD）年龄为46.0。（12.5）年。在干预组中，288名（26.0%）接听电话的参与者中有85人使用了拼车。干预组和对照组的错过预约率分别为36.5%（394人中的144人）和36.7%（392人中的144人）（P= 0.96）。结论和相关性拼车的使用率较低，并没有减少错过的初级保健预约。未来的研究试图减少错过预约，应探索替代交付模式或针对具有更强的交通需求的人群。
IMPORTANCE Transportation barriers contribute to missed primary care appointments for patients with Medicaid. Rideshare services have been proposed as alternatives to nonemergency medical transportation programs because of convenience and lower costs.OBJECTIVE To evaluate the association between rideshare-based medical transportation and missed primary care appointments among Medicaid patients.DESIGN, SETTING. AND PARTICIPANTS In a prospective clinical trial, 786 Medicaid beneficiaries who resided in West Philadelphia and were established primary care patients at 1 of 2 academic internal medicine practices located within the same building were included. Participants were allocated to being offered complimentary ride-sharing services (intervention arm) or usual care (control arm) based on the prescheduled day of their primary care appointment reminder. Those scheduled on even-numbered weekdays were in the intervention arm and on odd-numbered weekdays, the control arm. The primary study outcome was the rate of missed appointments, estimated using an intent-to-treat approach. All individuals receiving a phone call reminder were included in the study sample, regardless of whether they answered their phone. The study was conducted between October 24, 2016, and April 20, 2017.INTERVENTIONS A model of providing rideshare-based transportation was designed. As part of usual care, patients assigned to both arms received automated appointment phone call reminders. As part of the study protocol, patients assigned to both arms received up to 3 additional appointment reminder phone calls from research staff 2 days before their scheduled appointment. During these calls, patients in the intervention arm were offered a complimentary ridesharing service. Research staff prescheduled rides for those interested in the service. After their appointment, patients phoned research staff to initiate a return trip home.MAIN OUTCOMES AND MEASURES Missed appointment rate (no shows and same-day cancellations) in the intervention compared with control arm.RESULTS Of the 786 patients allocated to the intervention or control arm, 566 (72.0%) were women; mean (SD) age was 46.0. (12.5) years. Within the intervention arm, 85 among 288 (26.0%) participants who answered the phone call used ridesharing. The missed appointment rate was 36.5% (144 of 394) for the intervention arm and 36.7% (144 of 392) for the control arm (P=.96).CONCLUSIONS AND RELEVANCE The uptake of ridesharing was low and did not decrease missed primary care appointments. Future studies trying to reduce missed appointments should explore alternative delivery models or targeting populations with stronger transportation needs.