Health Policy Center, Urban Institute, Washington, District of Columbia, USA.
Health Policy Research Center, Mongan Institute, Massachusetts General Hospital, Boston, Massachusetts, USA.
Health Serv Res. 2022 Jun;57(3):472-481. doi: 10.1111/1475-6773.13899. Epub 2021 Nov 30.
To test whether there were fewer missed medical appointments ("no-shows") for patients and clinics affected by a significant public transportation expansion.
A new light rail line was opened in a major metropolitan area in June 2014. We obtained electronic health records data from an integrated health delivery system in the area with over three million appointments at 97 clinics between 2013 and 2016.
We used a difference-in-differences research design to compare whether no-show appointment rates differentially changed among patients and clinics located near versus far from the new light rail line after it opened. Models included fixed effects to account for underlying differences across clinics, patient zip codes, and time.
We obtained data from an electronic health records system representing all appointments scheduled at 97 outpatient clinics in this system. We excluded same-day, urgent care, and canceled appointments.
The probability of no-show visits differentially declined by 0.5 percentage points (95% confidence interval [CI]: -0.9 to -0.1), or 4.5% relative to baseline, for patients living near the new light rail compared to those living far from it, after the light rail opened. The effects were stronger among patients covered by Medicaid (-1.6 percentage points [95% CI: -2.4 to -0.8] or 9.5% relative to baseline).
Improvements to public transit may improve access to health care, especially for people with low incomes.
检验公共交通重大拓展对减少患者和诊所错过就诊预约（“爽约”）是否有影响。
一条新轻轨线路于 2014 年 6 月在一个主要大都市区开通。我们从该地区一个综合性医疗服务系统获取了电子健康记录数据，该系统在 2013 年至 2016 年间共提供了 97 个诊所的 300 多万次预约。
我们采用了一种差异中的差异研究设计，以比较在新轻轨线路开通后，位于轻轨沿线附近和远离轻轨沿线的患者和诊所的爽约预约率是否有差异变化。模型纳入了固定效应，以解释诊所、患者邮政编码和时间方面的潜在差异。
我们从电子健康记录系统中获取了该系统所有门诊预约的数据。我们排除了当天预约、紧急护理和已取消的预约。
与居住在远离轻轨地区的患者相比，轻轨开通后，居住在轻轨沿线附近的患者的就诊爽约率相对基线下降了 0.5 个百分点（95%置信区间[CI]：-0.9 至 -0.1），即下降了 4.5%。对于有医疗补助覆盖的患者，这种影响更为显著（-1.6 个百分点[95% CI：-2.4 至 -0.8]，或相对于基线下降了 9.5%）。
改善公共交通可能会改善医疗保健的可及性，特别是对低收入人群而言。
