Addressing Transportation Insecurity Improves Attendance at Posthospitalization Appointments

Area of Science:

• Pediatric Hospital Medicine
• Quality Improvement Science
• Health Services Research

Background:

• Transportation insecurity is a significant barrier to posthospitalization appointment (PHA) attendance in pediatric care.
• A previous study found 38% of PHAs were missed, with transportation issues being a key factor.
• A quality improvement project was initiated to address transportation insecurity during inpatient stays.

Purpose of the Study:

• To implement and evaluate an inpatient process for assessing and mitigating transportation insecurity.
• To improve attendance rates at posthospitalization appointments (PHAs) for pediatric patients.
• To reduce healthcare disparities caused by transportation barriers.

Main Methods:

• Utilized a plan-do-study-act (PDSA) framework for iterative improvement.
• Implemented interprofessional staff education on transportation insecurity assessment and resource navigation.
• Integrated transportation resource information into discharge instructions and provided family coaching.
• Established a system for notifying primary care providers about patients with transportation insecurity.

Main Results:

• Electronic health record documentation of transportation insecurity screening increased from 1% to 94%.
• Identification of families with transportation insecurity rose from 1.2% to 5%.
• Pediatric PHA attendance improved significantly, from 62% to 81% overall, and from 0% to 57% for patients with transportation insecurity.

Conclusions:

• Inpatient interventions effectively addressed transportation insecurity in pediatric patients.
• Mitigating transportation barriers during the hospital stay directly improved posthospitalization appointment adherence.
• This approach offers a scalable model for enhancing healthcare access and reducing missed appointments.