Corporal Michael Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania.
Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia.
JAMA Intern Med. 2018 Mar 1;178(3):383-389. doi: 10.1001/jamainternmed.2017.8336.
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.
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.
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.
Missed appointment rate (no shows and same-day cancellations) in the intervention compared with control arm.
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).
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.
clinicaltrials.gov Identifier: NCT02955433.
交通障碍导致医疗补助患者错过初级保健预约。拼车服务因其便利性和较低的成本而被提议作为非紧急医疗运输计划的替代方案。
评估基于拼车的医疗运输与医疗补助患者初级保健预约之间的关联。
设计、地点和参与者：在一项前瞻性临床试验中，纳入了居住在费城西部的 786 名医疗补助受益人和在同一栋楼内的 2 家学术内科实践中建立的初级保健患者。参与者根据其初级保健预约提醒的预定日期被分配到提供免费拼车服务（干预组）或常规护理（对照组）。偶数周工作日的参与者在干预组，奇数周工作日的参与者在对照组。主要研究结果是使用意向治疗方法估计的预约失约率。所有收到电话提醒的人都包括在研究样本中，无论他们是否接听电话。该研究于 2016 年 10 月 24 日至 2017 年 4 月 20 日进行。
设计了一种提供基于拼车的交通方式的模型。作为常规护理的一部分，分配到两组的患者都接受了自动预约电话提醒。作为研究方案的一部分，分配到两组的患者在预定预约前两天由研究人员进行了多达 3 次额外的预约提醒电话。在这些电话中，干预组的患者被提供免费的拼车服务。研究人员为有兴趣的人预约拼车。预约后，患者打电话给研究人员，要求送他们回家。
干预组与对照组相比的预约失约率（未出现和当天取消）。
在被分配到干预组或对照组的 786 名患者中，有 566 名（72.0%）为女性；平均（SD）年龄为 46.0.（12.5）岁。在干预组中，接听电话的 288 名参与者中有 85 名（26.0%）使用了拼车。干预组的预约失约率为 36.5%（144/394），对照组为 36.7%（144/392）（P = .96）。
拼车的使用率较低，并未减少初级保健预约的失约。未来试图减少预约失约的研究应探索替代的交付模式或针对交通需求更强的人群。
clinicaltrials.gov 标识符：NCT02955433。
