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Meta-Analysis
. 2022 Apr 21;22(1):799.
doi: 10.1186/s12889-022-13149-1.

Effect of interventions for non-emergent medical transportation: a systematic review and meta-analysis

Paul G Shekelle  1 , Meron M Begashaw  2 , Isomi M Miake-Lye  2 , Marika Booth  3 , Bethany Myers  4 , Andrew Renda  5
Affiliations
Meta-Analysis

Effect of interventions for non-emergent medical transportation: a systematic review and meta-analysis

Paul G Shekelle et al. BMC Public Health. .

Abstract

Introduction: Transportation is an important social determinant of health. We conducted a systematic review of the associations on health and health care utilization of interventions aimed at reducing barriers to non-emergency transportation and non-medical transportation.

Methods: We searched three databases and the gray literature through mid-January 2022. Included studies needed to assess an intervention targeted at non-emergency or non-medical transportation barriers, report missed (or kept) visits, health care utilization, costs, or health outcomes. Data extraction was performed in duplicate and included information about study design, results, and risk of bias. Primary outcomes were frequency of missed appointments, health care utilization, costs, and health outcomes. Synthesis was both narrative and meta-analytic using a random effects model.

Results: Twelve studies met inclusion criteria, three randomized trials, one controlled trial, and eight observational studies. All included studies had some element of risk of bias. Populations studied usually had chronic or serious health conditions or were poor. Interventions included van rides, bus or taxi vouchers, ride-sharing services, and others. Meta-analysis of seven studies (three trials, four observational studies) yielded a pooled estimate of missed appointments = 0.63 (95% confidence interval [CI] 0.48, 0.83) favoring interventions. Evidence on cost, utilization, and health outcomes were too sparse to support conclusions. Evidence on the effect of non-medical transportation is limited to a single study.

Conclusions and relevance: Interventions aimed at non-emergency transportation barriers to access health care are associated with fewer missed appointments; the association with costs, utilization or health outcomes is insufficiently studied to reach conclusions. This review was registered in PROSPERO as ID CRD42020201875.

Keywords: Health outcomes; Non-emergency medical transportation; Systematic review.

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Conflict of interest statement

Not applicable.

Figures

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Literature Flow
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Effect of Interventions to Reduce Transportation Barriers on Missed Appointments
See this image and copyright information in PMC

References

    1. Billioux A, Verlander K, Anthony S, Alley D. Standardized Screening for Health-Related Social Needs in Clinical Settings: The Accountable Health Communities Screening Tool. Washington, DC: NAM Perspectives. Discussion Paper, National Academy of Medicine; 2017. 10.31478/201705b. - DOI
    1. Syed ST, Gerber BS, Sharp LK. Traveling towards disease: transportation barriers to health care access. J Community Health. 2013;38(5):976–993. doi: 10.1007/s10900-013-9681-1. - DOI - PMC - PubMed
    1. National Academies of Sciences, Engineering, and Medicine . Cost-Benefit Analysis of Providing Non-Emergency Medical Transportation. Washington, DC: The National Academies Press; 2005.
    1. National Aging and Disability Transportation Center. New National Poll: Inability to Drive, Lack of Transportation Options are Major Concerns for Older Adults, People With Disabilities and Caregivers 2018. Available from: https://www.prnewswire.com/news-releases/new-national-poll-inability-to-.... Accessed 21 Jan 2022
    1. Crook H, Zheng J, Bleser W, Whitaker R, Masand J, Saunders R. How Are Payment Reforms Addressing Social Determinants of Health? Policy Implications and Next Steps. Duke Margolis Center for Health Policy; 2021.

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