Distance to travel affects specialty care access among homeless families

The New York Children's Health Project (NYCHP) provides primary care through mobile clinics to homeless families living in family or domestic violence shelters and to homeless street youth throughout the New York City area. NYCHP also facilitates medical and non-medical referrals through the Referral Management Initiative (RMI), recognized by the American Academy of Pediatrics as a Best Practice Model. RMI workers use transportation assistance and a web-based comprehensive tracking database system to facilitate appointment adherence. Since most shelters are away from main mass transit routes, and families are mandated to keep many other appointments related to permanent housing requirements, transportation assistance resulted in increased patient adherence to specialty care appointments. To further identify ways to increase adherence to these referrals, NYCHP examined trends regarding patients' shelter residence location in relation to subspecialty clinic locations. Medical specialty appointment adherence data during 2005 and 2006 were analyzed excluding non-medical referrals. Univariate analysis showed that over 69% of appointments were scheduled at our affiliate hospital's clinics in the Bronx. Using chi-square test of significance, patients who were sheltered in the Bronx were significantly more likely (p<.01) to keep their medical subspecialty appointments and overall patients' likelihood of keeping their appointments increased (p=.000) when their appointments were scheduled in clinics in the same borough as their current residence. These results suggest that in addition to providing transportation, travel distance to appointments may be a predictor of adherence. This session will discuss these findings and the importance of a referral management model for this population.