270977 Missed or delayed medical care appointments by older users of NEMT services

Tuesday, October 30, 2012 : 12:42 PM - 12:54 PM

Kara E. MacLeod, MPH, MA , School of Public Health, SafeTREC, University of California, Berkeley, CA
David R. Ragland, PhD, MPH , Safe Transportation Research & Education Center (SafeTREC), University of California Berkeley, Berkeley, CA
Thomas Prohaska, PhD , School of Public Health, University of Illinois at Chicago, Chicago, IL
Cheryl Irmiter, PhD, LCSW, CADC , Science, Medicine, and Public Health, American Medical Association, Chicago, IL
William Satariano, PhD , School of Public Health, University of California, Berkeley, Berkeley, CA
Reduced access to transportation can result in missed or delayed medical appointments. There is research to indicate that non-emergency medical transportation (NEMT) can reduce medical expenditures and improve quality of life by preventing emergency and hospital care as a result of missed appointments (Hughes-Cromwich & Wallace, 2006). While Medicaid provides NEMT for low income, minority populations, few studies have explored these services for older adults. This study aimed to explore factors associated with cancelled trips in a Medicaid, older adult population (age 65+). Multivariate logistic regression analyses were conducted using transportation brokerage data for Delaware members who scheduled a transportation appointment during 2008-2010 modeling the odds of all cancellations and then the following mutually exclusive types: (1) client cancelled; (2) client obtained alternative transportation; and (3) client cancelled due to health. Nearly 11% of over 152,000 scheduled trips were not taken. Patients receiving dialysis were less likely to cancel overall and for other types (ORs ranged 0.30-0.60). Older adults who were able to bring an escort were less likely to client cancel. Functional status was associated with an increased odds of cancelling for health reasons (OR=1.7 wheel chair and OR=2.4 stretcher). On average, patients receiving dialysis do not miss trips, however, more research is needed to understand the impact of missed NEMT for patients with other health issues. These types of studies can provide important insight for improving the effectiveness of Medicaid NEMT and can assist in developing programs and policies for improving health care utilization and reducing missed appointments.

Learning Areas:
Public health administration or related administration
Public health or related public policy
Public health or related research

Learning Objectives:
1) List factors associated with missed non-emergency medical transportation among older adults; and 2) Discuss potential directions for future research and program improvements.

Keywords: Aging, Access and Services

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I conducted the analyses for the findings presented here.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.