Association of Rideshare-Based Transportation Services and Missed Primary Care Appointments: A Clinical Trial
IMPORTANCE: Transportation barriers contribute to missed primary care appointments for patients with Medicaid. Rideshare services have been proposed as alternatives to nonemergency medical transportation programs because of convenience and lower costs.
OBJECTIVE: To evaluate the association between rideshare-based medical transportation and missed primary care appointments among Medicaid patients.
DESIGN, SETTING, AND PARTICIPANTS: In a prospective clinical trial, 786 Medicaid beneficiaries who resided in West Philadelphia and were established primary care patients at 1 of 2 academic internal medicine practices located within the same building were included. Participants were allocated to being offered complimentary ride-sharing services (intervention arm) or usual care (control arm) based on the prescheduled day of their primary care appointment reminder. Those scheduled on even-numbered weekdays were in the intervention arm and on odd-numbered weekdays, the control arm. The primary study outcome was the rate of missed appointments, estimated using an intent-to-treat approach. All individuals receiving a phone call reminder were included in the study sample, regardless of whether they answered their phone. The study was conducted between October 24, 2016, and April 20, 2017.
INTERVENTIONS: A model of providing rideshare-based transportation was designed. As part of usual care, patients assigned to both arms received automated appointment phone call reminders. As part of the study protocol, patients assigned to both arms received up to 3 additional appointment reminder phone calls from research staff 2 days before their scheduled appointment. During these calls, patients in the intervention arm were offered a complimentary ridesharing service. Research staff prescheduled rides for those interested in the service. After their appointment, patients phoned research staff to initiate a return trip home.
MAIN OUTCOMES AND MEASURES: Missed appointment rate (no shows and same-day cancellations) in the intervention compared with control arm.
- : Of the 786 patients allocated to the intervention or control arm, 566 (72.0%) were women; mean (SD) age was 46.0. (12.5) years. Within the intervention arm, 85 among 288 (26.0%) participants who answered the phone call used ridesharing. The missed appointment rate was 36.5% (144 of 394) for the intervention arm and 36.7% (144 of 392) for the control arm (P = .96).
Conclusions and Relevance: The uptake of ridesharing was low and did not decrease missed primary care appointments. Future studies trying to reduce missed appointments should explore alternative delivery models or targeting populations with stronger transportation needs.
Overview of article
- This study evaluates the association between rideshare-based medical transportation and missed primary care appointments among Medicaid patients
- Medicaid beneficiaries face transportation barriers when accessing primary care and may miss appointments. This has a negative impact on healthcare professionals’ clinical productivity and revenue. Despite the availability of non-emergency medical transportation (NEMT), transportation barriers persist
- Ridesharing, such as Uber and Lyft have been proposed as alternatives because they can scheduled as needed, use direct routes, are readily available in most areas, and cost less
Methods of article
- Researchers developed a model for providing transportation using Lyft’s dispatch platform with the aim of reducing missed appointments in 2 primary care practices in Philadelphia. The trial was conducted between October 2016 and April 2017 in 2 primary care practices within Penn Medicine. Patients were allocated to either the intervention or the control based on the day of the week of a prescheduled phone appointment reminder (2 days before their appointment)
- Patients allocated to the intervention were contacted by a research assistant and were offered free transportation to and from their appointment using Lyft. Patients allocated to the control arm received robo calls and phone call reminders from study staff
- The study team used Dispatch to schedule transportation. Because requests and routes were initiated by study staff, patients were not required to have a smartphone or app. Missed appointment rates were calculated for the intervention and control arms as the number of no-shows and same-day cancellations divided by the total number of patients in the study arm based on data within the electronic medical record. The researchers also examined impacts to ED visits (at Penn Medicine facilities) within 7 and 30 days following the PCP appointment
- The study sample included 786 patients, with 394 patients in the intervention arm and 392 in the control arm. Within the intervention arm, 162 (56.3%) people were not interested in rideshares. Among the 288 patients who answered the phone, 104 (36.1%) were interested, 11 (3.8%) were not offered the Lyft ride because they needed a wheelchair-accessible ride or did not have a text-capable phone, 93 (32.3%) consented and had a ride to clinic scheduled, and 55 (19.8%) used the service
- The missed appointment rate in the intervention arm was 36.5% vs 36.7% (P = .96) in the control arm. There were no significant differences in 7-day or 30-day rates of emergency department visits in the unadjusted or adjusted analyses controlling for clinician types. The mean (SD) cost per patient who consented was $14.00 ($6.88); range, $0 to $40.17