Rideshare-Based Medical Transportation for Medicaid Patients and Primary Care Show Rates: A Difference-in-Difference Analysis of a Pilot Program
Rideshare-Based Medical Transportation for Medicaid Patients and Primary Care Show Rates: A Difference-in-Difference Analysis of a Pilot Program
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DOI：
10.1007/s11606-018-4306-0
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发表时间：
2018-06-01
影响因子：
5.7
通讯作者：
Grande, David
中科院分区：
文献类型：
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作者：
Chaiyachati, Krisda H.;Hubbard, Rebecca A.;Grande, David
尽管可以获得非紧急医疗运输（NEMT）福利，但运输到初级保健是医疗补助患者的一个有据可查的障碍。拼车服务提供了更大的便利性和更低的成本，已被提议作为NEMT的替代方案。评估基于拼车的医疗交通对参加预定初级保健预约的医疗补助患者比例的影响。在两种类似实践之一中，所有符合条件的医疗补助患者都获得了基于拼车的交通服务（“拼车实践”）。采用具有稳健标准误的逻辑回归的差异中差异分析方法来比较拼车实践与不提供拼车的实践之间的显示率变化（“对照实践”）。我们的研究人群包括西费城的居民，他们由医疗补助保险，并且是位于同一栋建筑物内的两个学术普通内科实践的既定患者。我们设计了一个乘车共享-基于交通试点干预。在预约前2天的提醒电话中为患者提供服务，并由研究人员提供乘车服务。然后，患者打电话给研究人员，安排他们回家的时间。我们通过比较从基线期到干预期的拼车实践的平均显示率的变化，评估了提供基于拼车的交通对预约显示率的影响。在对照实践中，显示率从60%（146/245）下降到51%（34/67）。在拼车实践中，显示率从54%（72/134）提高到68%（41/60）。在调整后的模型中，控制患者人口统计学和提供者类型，在干预前后出现预约的几率增加了2.57倍（1.10-6.00）在乘车共享实践中比对照practice.Results该试点计划表明，提供基于乘车共享的运输服务可以增加显示率医疗补助患者的初级保健。
Transportation to primary care is a well-documented barrier for patients with Medicaid, despite access to non-emergency medical transportation (NEMT) benefits. Rideshare services, which offer greater convenience and lower cost, have been proposed as an NEMT alternative.To evaluate the impact of rideshare-based medical transportation on the proportion of Medicaid patients attending scheduled primary care appointments.In one of two similar practices, all eligible Medicaid patients were offered rideshare-based transportation ("rideshare practice"). A difference-in-difference analytical approach using logistic regression with robust standard errors was employed to compare show rate changes between the rideshare practice and the practice where rideshare was not offered ("control practice").Our study population included residents of West Philadelphia who were insured by Medicaid and were established patients at two academic general internal medicine practices located in the same building.We designed a rideshare-based transportation pilot intervention. Patients were offered the service during their reminder call 2 days before the appointment, and rides were prescheduled by research staff. Patients then called research staff to schedule their return trip home.We assessed the effect of offering rideshare-based transportation on appointment show rates by comparing the change in the average show rate for the rideshare practice, from the baseline period to the intervention period, with the change at the control practice.At the control practice, the show rate declined from 60% (146/245) to 51% (34/67). At the rideshare practice, the show rate improved from 54% (72/134) to 68% (41/60). In the adjusted model, controlling for patient demographics and provider type, the odds of showing up for an appointment before and after the intervention increased 2.57 (1.10-6.00) times more in the rideshare practice than in the control practice.Results of this pilot program suggest that offering a rideshare-based transportation service can increase show rates to primary care for Medicaid patients.