The evaluation and cost-benefit analysis of a nonemergency private transportation program for low-income adults in a rural setting

IF 3.2 3区工程技术 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Journal of Transport & Health Pub Date : 2024-10-17 DOI:10.1016/j.jth.2024.101929

Alice R. Richman , Abby J. Schwartz , Haiyong Liu , Mallary Scott , Weyling White , Caroline Doherty

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Abstract

Background

Access to transportation can improve the health of communities. Since 2015, Project TRIP (Transporting Residents with Innovative Practices) has offered free nonemergency privately operated individualized transportation for low-income residents in rural eastern North Carolina. We sought to evaluate the impact of Project TRIP on health outcome and healthcare utilization measures and to conduct an economic evaluation of its cost benefit.

Methods

Key health outcome and healthcare utilization variables were compared across 101 Project TRIP users before and after TRIP participation via data obtained from electronic health records from 2017 to 2021. The cost-benefit analysis included a comparison of the costs of operating Project TRIP as compared to the savings of fewer hospital and emergency department admissions. Pre and post TRIP comparisons were analyzed on the following: A1C scores, no show/missed appointments, body weight, body mass index, and number of emergency room and hospital admissions.

Results

Over half (58%) of Project TRIP users were female with a mean age of 54. Most riders were Black (69%), either received Medicaid (32%) or Medicare (17%) or were uninsured (22%). All variables showed a decrease (improvement) post TRIP utilization. The average A1C level decreased by 0.52 post TRIP utilization (statistically significant at 10% level). The number of hospital admissions also decreased (statistically significant at 1% level) for TRIP users. Other key measures also improved for TRIP users but not at statistically significant levels. The estimated net savings of Project TRIP in hospital and emergency room visits alone after deducting operating costs in the past 5 years was $720,544.

Conclusions

This study found that access to a non-emergency medical transportation program was cost-effective in reducing emergency room and hospital expenditures. Project TRIP users demonstrated an improvement in health outcomes post TRIP utilization. Expanding model rural transit programs and policies are needed.

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针对农村地区低收入成年人的非紧急私人交通计划的评估和成本效益分析

背景交通可以改善社区的健康状况。自 2015 年以来，TRIP 项目（以创新实践接送居民）为北卡罗来纳州东部农村地区的低收入居民提供了免费的非紧急私人个性化交通服务。我们试图评估 TRIP 项目对健康结果和医疗保健利用措施的影响，并对其成本效益进行经济评估。方法通过从 2017 年至 2021 年的电子健康记录中获取的数据，比较了 101 名 TRIP 项目用户在参与 TRIP 项目前后的主要健康结果和医疗保健利用变量。成本效益分析包括比较 TRIP 项目的运营成本与因减少住院和急诊入院而节省的费用。TRIP 项目前后的比较分析如下：结果超过一半（58%）的 TRIP 项目用户为女性，平均年龄为 54 岁。大多数使用者为黑人（69%），有的接受医疗补助（32%）或医疗保险（17%），有的没有保险（22%）。使用 TRIP 后，所有变量都有所下降（改善）。使用 TRIP 后，平均 A1C 水平下降了 0.52（在 10%的水平上具有统计学意义）。TRIP 使用者的入院次数也有所减少（在 1%的水平上有统计学意义）。TRIP 用户的其他关键指标也有所改善，但在统计上没有显著意义。在扣除过去 5 年的运营成本后，估计 TRIP 项目仅在医院和急诊室就诊方面就净节省了 720,544 美元。使用 TRIP 项目后，用户的健康状况有所改善。需要扩大示范性农村交通计划和政策。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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