According to the American Hospital Association (AHA), transportation challenges prevent a staggering 3.6 million Americans from receiving medical care each year. A 2019 survey by Kaiser Permanente found that one-third of Americans frequently or occasionally experience stress over their families' transportation needs.
While access to a reliable personal vehicle or public transit system can affect virtually any patient at any point in time, it can be persistently problematic for the roughly one-in-five patients residing in rural areas who experience commutes 17 minutes longer and 10.5 miles farther than their urban and suburban counterparts. Associated travel expenses pose additional barriers, especially for those with mobility-limiting conditions requiring specialized vehicles or with chronic conditions requiring repeated visits.
When lack of transportation leads to missed, canceled, or delayed appointments, the impact on patients and providers is significant, interrupting continuity of care and compromising patient outcomes as well as the successful management of complex comorbidities. The rise in such scenarios has prompted the creation and implementation of targeted solutions. "Addressing social needs [like transportation] is the next frontier in healthcare," says Edward Lee, MD, executive vice president of information technology and chief information officer at the Permanente Federation in Oakland, Calif. "An individual's social needs can have a huge impact on their health; physicians are often the first professionals working in a community to identify those needs."
Social determinants of health (SDOH)—where patients are born, live, learn, and work—are increasingly being studied as a way to stymie existing health inequities, improve access to both acute and preventive care, and address modifiable risk factors. According to the Centers for Disease Control and Prevention (CDC), genetic, biologic, and personal behaviors account for just 25 per cent of an individual's wellness. The remaining 75 per cent is attributed to SDOH factors like housing, safe neighborhoods, food insecurity, and access to transportation and healthcare services.
The true cost of missed appointments
When patients cannot attend appointments, regardless of the reason, it creates a cascade of consequences for all involved. An interruption in the continuity of care and access to critical support services can leave patients struggling to independently maintain treatment regimens and make healthful decisions that advance their care plans.
According to a 2018 Journal of Primary Care and Community Health study, patients with a history of missed appointments are nearly five times more likely to miss subsequent appointments. Another study determined that patients with higher rates of no-shows are significantly more likely to have incomplete preventive cancer screenings, worse chronic disease control, and increased rates of acute care utilization for hospitalization and emergency department visits, adding to healthcare costs in an already overburdened system. Missed appointments are a risk factor for all-cause mortality, according to a 2019 BMC Medicine study, with mental health patients experiencing an eightfold increase in risk.
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