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

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.