The Right Direction

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 Roads

Transportation barriers, and alternatives to transportation in healthcare, remain opaque in delivery focus. Given the sophistication in global citizenry and global policy, as well as the sophistication of climate science evolution, oversight for transportation in healthcare can be improved. Healthcare transportation oversight should focus on improvement to both quantity and quality.

 

Quantity

*Collaborate and clarify the impact of transportation on healthcare. How much healthcare is missed due to lack of transportation? Estimates of deferred visits due to transportation barriers are available as piecemeal [1,2]. Be specific for populations, too. Global health data may isolate specific case studies. United States or other high-income countries may research healthcare transportation as a social determinant of care [3], without specifics on cost, cost savings, or the barrier’s impact on healthcare. It would be best to have ongoing, reliable data on health burden and impact as a result of transportation barriers.  

*Quantify impact using health outcome metrics, wherever possible. What is the impact of all the preventative care visits missed? What is the impact on trauma care delay, or on pediatric delays? What is the impact on prescription interruptions?  What is the impact of mental healthcare disruption?

*Quantify use of transportation in healthcare, by type. Remain accountable to ambulance service definitions in various countries and include all varieties of public health transportation in various countries.  

*Survey counts of transportation methods used to receive healthcare, with shared economy inclusion. Uber, Lyft and similar alternative use should be measured. 

*Measure and compare health organization “coupons” or free ride partnerships, and weave this into quality indicators. The metric should be reported on regularly, either through accreditation or through local public health for state and federal aggregation. As health organizations begin to track and credit ride partnerships, health organizations can begin to ask about transportation as part of the medical visit. Begin with basic numbers of rides.

*Measure transportation availability by physical or cognitive disability. 

*Quantify rural and urban considerations. 

*Quantify direct and indirect transportation impacts on healthcare, separate from climate and environmental impact.  Be specific with acute care, and be specific with indirect, broader transportation [4] and public health [5]. Climate and environmental health are a magnetic pivot in today’s geopolitics, yet we are here to tackle physical transportation to and from healthcare.  Require focus and measure accordingly. 

*Perform a literature search, inclusive of WHO bulletins [6], to examine quantity of data and quantity of health messaging around transportation in healthcare. Ensure that the data and messaging is separated from transportation ties to environmental health.

Quality

*Define transportation, and consider an adjective moving forward. It matters if an elderly patient wishes that someone other than their child transport them to their physician. It matters if a woman is reliant on her husband to drive her to the hospital, when she wishes she could take the ride alone. Perhaps safe transportation, preferred transportation or reliable transportation are more appropriate terms moving forward, and a global consensus should drive this.

*Be specific for disability access to transportation, by definition, by system, with policy analytics and by country. 

Determine methodology of transportation analytics [5]. How is rural and urban defined, and how can geography be standard for international assessments. How is transportation definition, roadway access definition and emergency transport analyzed? 

*Define the outcomes to be measured. What are basic metrics to observe health outcomes and transportation? 

*Analyze the shared ride economy. Barriers that include cost, receipt tracking (for individuals who share banking cards) and other factors should be weighed, and should be assessed through survey and structured analytics. A country’s policies with shared driving should be compared. 

*Analyze the recommendations for evidence-based movement in research and delivery in transportation alternatives to care, such as telehealth and home visiting. Report on current statistics (use, cost, savings, health outcomes) and movement forward. 

*Report on current and future planning around quality accreditation with transportation inclusion. Should healthcare incorporate transportation in basic assessment fields of the EMR, and should the canned “barriers” field be no longer acceptable? Should the number of patient services turned down due to transportation be recorded? Will healthcare organizations receive incentives if transportation barriers are identified and removed? WIll healthcare organizations who record a transportation barrier and subsequent missed care for the patient be asked for process improvement strategies? Or, will missed care be a responsibility of local governments? 


Delivering and receiving healthcare is difficult enough; roadblocks in transportation to healthcare should be eliminated. This can and should be improved, worldwide. 



  1. https://ajph.aphapublications.org/doi/10.2105/AJPH.2020.305579

  2. https://www.nap.edu/download/23638

  3. https://www.aha.org/ahahret-guides/2017-11-15-social-determinants-health-series-transportation-and-role-hospitals

  4. https://www.nap.edu/download/25644

  5. https://journals.sagepub.com/doi/10.1177/0361198120952793

  6. https://www.who.int/news/item/08-11-2021-many-countries-are-prioritizing-health-and-climate-change-but-lack-funds-to-take-action

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