I have often had patients and their families tell me that they can’t make an appointment or have missed an appointment because they don’t have transportation. We have all heard of “housing insecurity” or “food insecurity,” but I had never really heard the phrase “transportation insecurity” until I read this Quality Report entitled, “Addressing Transportation Insecurity Improves Attendance at Post-Hospitalization Appointments,” by Dr. Sarah Hoffman and colleagues at Maine Medical Center (10.1542/peds.2020-032862). The article is being early released by Pediatrics this week.
After the authors noted that several parents cited transportation issues as reasons for missing their child’s follow-up appointment after hospitalization, they designed a QI project to improve follow-up appointment show rates by screening for transportation insecurity and providing information about transportation resources to families and providers. Although many families are eligible through their state health insurance for non-emergency transportation services (taxis, shuttles, etc.), most are unaware of this service. Thus, this QI project revolved around educating patients about this service, providing the information in printed patient discharge instructions, and prompting case managers, social workers, and other hospital staff to teach the family how to access this service.
Reading this Quality Report was one of those “light bulb moments” for me. Why have we never thought of doing this? Although I’ve often obtained bus or taxi vouchers for families, we haven’t considered more sustainable solutions for families. Whether you work in primary care, subspecialty care, or in hospital care, I would venture that many of the families with whom you work have transportation insecurity. I also suspect that, when you read this Quality Report, it will spur you and your team to try something similar to this!