Female nurse checking on a smiling elderly patient

It’s not just transportation, it’s health justice for patients

Study finds that current social risks screening does not capture patients’ transportation needs

(SACRAMENTO)

About 5.8 million Americans miss or delay medical care annually because of transportation barriers. This has a major impact on their ability to take care of their health. Na’amah Razon, assistant professor of family and community medicine at UC Davis Health, researches how medical providers screen patients about their transportation needs and how that affects patients’ access to health care.

In the following Q&A, Razon shares her findings from a recent study which analyzed transportation screening and assessment questions used in adult clinics to understand how these tools assess patients’ mobility and transportation needs.

What did your study find about current transportation screening tools?

Our study identified 23 unique social risk screening tools. Only 14 of these tools included one or more transportation questions.

We found that the existing transportation screening tools do not uniformly or comprehensively assess transportation needs. They differed in their content, structure and response options. They also typically failed to surface relevant information on financial constraints, disability, local transportation options and social isolation. For many individuals, this may mean missing their actual transportation security concerns.

Why do current transportation screening questions fail to capture patients’ needs?

Female nurse checking on a smiling elderly patient
Screening questions can help identify health care access issues 

Our study demonstrated how our ability to intervene effectively on transportation security might be limited by the kind of screening questions and assumptions we have. We found that there's no gold standard for these screening questions. For example, if you ask people ‘do you have a car?’ they're only going to answer whether they have one or not. The question doesn’t address broader transportation needs, such as navigating public transportation, mobility concerns or financial constraints for gas.

For this reason, we need to broaden the idea of transportation. It shouldn’t be only about securing a ride to the appointment. It requires thinking more deeply about issues such as, “Can this individual get up and down their stairs? Would they benefit more from telehealth services? Should they be connected to public health nursing for more home care?”

Transportation is much more than access to a car, which historically has been the focus of these screening questions.

How does better screening for transportation and social determinants of health benefit the patient?

There's been an increasing understanding within health systems that addressing social risk is part of health care. What happens outside the clinic walls matters to the patients’ health and well-being. It impacts their ability to come to medical appointments, access food and clothing, and take care of themselves.

I think the screening questions are meant to identify the problem, but I am not convinced that we have the right questions to capture transportation insecurity comprehensively. The disconnect between interest in transportation and poor uptake of current transportation programs presents an opportunity to improve transportation needs assessments and transportation solutions.

It is time to develop more robust tools to address health care accessibility. Valid, feasible screening and assessment tools that accurately identify specific transportation needs will improve the range and effectiveness of transportation solutions and better serve patients’ mobility needs. In our study discussion, we suggest using a brief screening question that broadly captures transportation insecurity, followed by a more comprehensive assessment when triggered by a positive response.

Na’amah Razon
We need to broaden the idea of transportation. It shouldn’t be only about securing a ride to the appointment.”Na’amah Razon

Who needs to know about transportation screening tools?

There is a need to better identify individuals facing transportation insecurity and develop transportation solutions that address their transportation needs. Three main groups may benefit from learning more about transportation screening tools. 

  • Health care practitioners: As healthcare systems integrate social determinants screening, providers need to consider what questions they should be asking and what potentially are they not capturing by these questions.
  • Health care payers: Some insurances, like Medicaid and certain Medicare Advantage plans, allow transportation benefits. While people may be eligible for these benefits, there is more work to connect eligible patients and improve design to best serve needs.
  • Patients: Patients don't always realize they have benefits through their insurance. Meaningful screening is something that medical providers can use to help patients access transportation benefits.

The study was published in the Journal of the American Board of Family Medicine. Razon’s co-author is Laura Gottlieb, founding co-director of the Social Interventions Research and Evaluation Network (SIREN) at the University of California, San Francisco. Razon is affiliated with UC Davis Center for Healthcare Policy and Research.

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