Inclusive Planning to Evaluate Improved Non-Emergency Medical Transportation Services for Patients With End Stage Renal Disease

摘要

The objective of this project is to design a framework that could be used to evaluate the effectiveness and efficiency of non-emergency transportation services (NEMT) for better livability. In addition to the development of the framework, this project aimed to establish connections between Portland State University (PSU) researchers with regional connections involved in public health research, non-emergency medical transportation, medical services, and medical insurance provision. With the rising costs of transportation and medical costs generally in the United States, it is increasingly important to develop new tools and strategies to reduce these costs while maintaining and improving upon the level of care provided. Ultimately, the inability to afford NEMT can lead to missed appointments and reduced access to medical care for vulnerable populations, which in turn can lead to more trips to the emergency room and reduced quality of life. This impacts not only individuals, but the communities that these individuals are a part of.A robust literature review and background research laid the groundwork for this project. This literature review provides an overview of the body of literature that analyzes how non-emergency medical transportation is provided in the United States and also highlights gaps in the existing research. Special attention is paid to the challenges of patients with end-stage renal disease (ESRD), who require routine NEMT service for dialysis appointments. The emerging focus on community-based participatory research (CBPR) is also discussed as a potential tool for better incorporating qualitative data into future analyses of the costs and benefits of providing NEMT. In this process, we identified key strategies for improving NEMT, including better coordination between dialysis clinics and NEMT providers, consideration of fixed-route transportation and improvements in dispatch technology.We developed a framework for evaluating NEMT program changes that centers on a hybrid cost-benefit analysis matrix, modeled on a CBPR approach developed by Stevens et al. for their 2008 evaluation of an Australian childcare strategy. The matrix was refined via feedback from Ride Connection’s advisory committee, and is tailored to many of the unique challenges facing NEMT programs. In conjunction with the hybrid costbenefit analysis framework, a preliminary patient survey instrument was developed to facilitate the collection of data to evaluate transportation policy or program changes for NEMT providers. These tools represent the first steps to researching, evaluating and improving NEMT for healthier and more livable communities