National Center for Transit Research | A Program of the Center for Urban Transportation Research at the University of South Florida
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Improving Transportation Access to Health Care Services

(Center Identification Number: 79062-20)

Principal Investigator:

Kristine Williams
University of South Florida
4202 E Fowler Avenue CUT 100
Phone number: 813-974-9807
Email address: kwilliams@cutr.usf.edu

 

Project Scope

Millions of people across the U.S. are unable to provide their own transportation due to age, disability or income constraints. Although the size of this transportation disadvantaged (TD) population is not fully known, the GAO states that the population is large, with about 40 million people 65 and over, 46 million people in poverty, and 3.6 million veterans having a service-related disability (GAO-15-110 Transportation Disadvantaged Populations). In Hillsborough County alone, nearly 600,000 people will be transportation disadvantaged by 2040 (Hillsborough MPO, Transportation Disadvantaged Service Plan 2016-2021).

Transportation disadvantaged (TD) persons often experience challenges obtaining transportation to and from non-emergency health care services. In a recent Hillsborough MPO forum, half of the 30 health and social service providers in attendance said their TD clients expressed concerns with transportation every day. Unmet needs included lack of access to and from health education, mental health and substance abuse programs, dialysis centers, follow-up visits, medical testing and other health care services. Forum attendees cited limited availability of public transportation, lack of transportation options serving late-night or weekend needs, payment processing difficulties, high out-of-pocket costs, limited capacity of transit systems to handle wheelchairs and scooters, and inadequate pedestrian facilities and safety as primary reasons for lack of access. Residents of assisted living facilities further expressed an increased sense of isolation due to limited transportation options.

Applied research is sorely needed to determine how to help service providers better connect the growing TD population to the health services they need. The impact of such research cannot be overstated given funding shortages for public transportation, pressures to reduce Medicaid spending, growing demand for TD services, and the potential explosion in public costs for late or missed health care treatments. At the same time, emerging technology and mobility on demand services are creating opportunities for cost-effective and innovative solutions.

This study will synthesize national best practices in mobility management and service coordination or interagency partnerships relative to health care access for the transportation disadvantaged. It will then apply these findings, using Hillsborough County as a laboratory, in the form of a strategic action plan framework for improving transportation access to health services. One or more agencies will also be selected in collaboration with the Hillsborough MPO for detailed examination and conceptual demonstration of potential applications.

Specific research objectives include:

  1. Document common gaps and barriers nationally and in the Tampa Bay region that are experienced by transportation-disadvantaged persons in obtaining transportation access to health services, as well as challenges experienced by healthcare service providers in improving transportation access.
  2. Identify and document potential strategies and innovative practices for improving transportation access to and from health services, such as creative partnerships, mobility on demand services, special software applications, improved coordination of transportation and health care scheduling, locational efficiencies and other emerging strategies identified through the research.
  3. Develop a conceptual strategic action plan framework building on needs of providers in the Tampa Bay region that identifies how the potential innovations or collaborative solutions might be applied to address gaps or barriers in access to health services.
  4. Document the findings and lessons learned in a final report that will provide strategic guidance and case examples to help MPOs and other agencies wishing to increase accessibility of TD populations to health and social services.

Supporting Tasks and Deliverables:

The research will involve the following key tasks:

Task 1: Assessment of Barriers and Strategies

This task will involve two key subtasks:

1.1 Identify and document frequent gaps and barriers faced by transportation disadvantaged persons seeking access to healthcare, as well as challenges faced by transportation and healthcare service providers in providing such access. The assessment will consider both national trends, as well as trends specific to the Hillsborough County region. This will be accomplished through:

  1. A review of national literature, selected TD plans in Florida and other states, and Hillsborough County plans and documents.
  2. Interviews and meetings with transportation agency personnel, transportation service providers, healthcare service providers, and other stakeholders to gather information on the gaps and barriers of healthcare access and for improving access.

1.2 Identify potential strategies and innovative practices for addressing the identified gaps and barriers, such as creative partnerships among transportation and health service providers, mobility on demand services, special software applications, improved coordination of transportation and health care scheduling, locational efficiencies and other strategies identified through the research. This will be accomplished through:

  1. A review of national literature, studies, and documents from relevant projects and initiatives, such as projects funded under the USDOT’s “Rides to Wellness Demonstration and Innovative Coordinated Access and Mobility Grants”, the work of the Coordinating Council on Access and Mobility (CCAM), the Centers for Medicare and Medicaid Services’ Accountable Health Communities, the “Smart Cities” initiative, and other programs as identified through the national literature and internet.
  2. Targeted interviews and internet meetings with knowledgeable persons involved in key projects identified in the national review to gather first-hand information on key practices, including lessons learned and implementation details (e.g., costs, timeframes, responsible parties, success factors, etc.).

Deliverable: Technical Memorandum 1 – Common Challenges and Innovative Solutions for Improving Access to Healthcare Services.

The deliverable will identify gaps and barriers as well as potential solutions for enhancing accessibility to health services for transportation disadvantaged and implementation details.

Task 2: Conceptual Strategic Action Plan Framework to Address Healthcare Access for the Transportation Disadvantaged

Findings from Task 1 will be compiled in the form of a conceptual strategic action plan framework for increasing access to healthcare services for the transportation disadvantaged. The conceptual framework will be completed with input and advice from Hillsborough MPO staff, local health service agencies, transportation service providers, and other knowledgable parties. The framework will pair barriers or needs to be addressed with specific strategies, identify responsible parties and opportunities for partnering or collaboration, and explore resource needs and potential funding sources or resource sharing options. Case examples of applications in other areas and contacts for further information may also be included where available. The plan framework will be designed to address needs and providers in the Tampa Bay region, but with an eye toward guiding other regions that may face similar challenges.

Deliverable #2: Conceptual Strategic Action Plan to Address Healthcare Access for Transportation Disadvantaged

Task 3: Draft and Final Report

The results of the research will be compiled in a draft and final report that includes the findings from Tasks 1-2. The draft final report will be well written and follow the Guidelines for University Presentation and Publication of Research. It will be edited for technical accuracy, grammar, clarity, organization, and format.

Deliverable #4a: Draft Final Report

Ninety (90) days prior to the end date of the task work order, the team will prepare a draft final report that will include an executive summary and a synthesis of study findings compiled from each of the previous deliverables, with additional details as necessary to illustrate the study findings. It will be provided in both PDF and MS Word formats. The report will be well written and edited for technical accuracy, grammar, clarity, organization, and format. It will follow the Guidelines for University Presentation and Publication of Research available at http://www.fdot.gov/research/docs/T2/University.Guidelines.2016.pdf.

Task 4: Final Report

The research team shall prepare a final report that addresses any comments or questions of selected participants in the research following review of the draft final report. The final report will be well written and follow the Guidelines for University Presentation and Publication of Research. It will be edited for technical accuracy, grammar, clarity, organization, and format.

Deliverable #5a: Final Report

 

Other Tasks that may be accomplished pending the ability to obtain additional grant funding or in-kind contributions.

Task XX: Case Study Application and Strategic Plan Refinement

The research team will conduct a detailed case study of potential application of the strategies in the context of one health service provider, to be selected in coordination with the Hillsborough MPO. This will consist of a conceptual demonstration and analysis of potential benefits and costs associated with the proposed strategies. The strategic plan will be further updated and refined as appropriate, based upon the findings of the case study application. Budget ($50,000)

Deliverable #3: Technical Memorandum –Case Study Findings for Improving Healthcare Access

Project Schedule

It is anticipated that the research project outlined in the scope of work will be completed within fifteen (15) months.

 

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National Center for Transit Research c/o Center for Urban Transportation Research 4202 E. Fowler Ave., CUT100 Tampa, FL 33620-5375