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2021 T R A N S I T C O O P E R A T I V E R E S E A R C H P R O G R A M TCRP RESEARCH REPORT 223 Research sponsored by the Federal Transit Administration in cooperation with the Transit Development Corporation Subject Areas Policy and Planning Guidebook and Research Plan to Help Communities Improve Transportation to Health-Care Services KFH Group, Incorporated Austin, TX, and Bethesda, MD i n a s s o c i a t i o n w i t h norc at tHe unIversIty oF cHIcaGo Bethesda, MD
TCRP RESEARCH REPORT 223 Project H-55 ISSN 2572-3782 ISBN 978-0-309-67356-3 Â© 2021 National Academy of Sciences. All rights reserved. COPYRIGHT INFORMATION Authors herein are responsible for the authenticity of their materials and for obtaining written permissions from publishers or persons who own the copyright to any previously published or copyrighted material used herein. Cooperative Research Programs (CRP) grants permission to reproduce material in this publication for classroom and not-for-profit purposes. Permission is given with the understanding that none of the material will be used to imply TRB, AASHTO, FAA, FHWA, FTA, GHSA, NHTSA, or TDC endorsement of a particular product, method, or practice. It is expected that those reproducing the material in this document for educational and not-for-profit uses will give appropriate acknowledgment of the source of any reprinted or reproduced material. For other uses of the material, request permission from CRP. NOTICE The research report was reviewed by the technical panel and accepted for publication according to procedures established and overseen by the Transportation Research Board and approved by the National Academies of Sciences, Engineering, and Medicine. The opinions and conclusions expressed or implied in this report are those of the researchers who performed the research and are not necessarily those of the Transportation Research Board; the National Academies of Sciences, Engineering, and Medicine; or the program sponsors. The Transportation Research Board; the National Academies of Sciences, Engineering, and Medicine; and the sponsors of the Transit Cooperative Research Program do not endorse products or manufacturers. Trade or manufacturersâ names appear herein solely because they are considered essential to the object of the report. TRANSIT COOPERATIVE RESEARCH PROGRAM The nationâs growth and the need to meet mobility, environmental, and energy objectives place demands on public transit systems. Cur- rent systems, some of which are old and in need of upgrading, must expand service area, increase service frequency, and improve efficiency to serve these demands. Research is necessary to solve operating prob- lems, adapt appropriate new technologies from other industries, and introduce innovations into the transit industry. The Transit Coopera- tive Research Program (TCRP) serves as one of the principal means by which the transit industry can develop innovative near-term solutions to meet demands placed on it. The need for TCRP was originally identified in TRB Special Report 213âResearch for Public Transit: New Directions, published in 1987 and based on a study sponsored by the Urban Mass Transportation Administrationânow the Federal Transit Administration (FTA). A report by the American Public Transportation Association (APTA), Transportation 2000, also recognized the need for local, problem- solving research. TCRP, modeled after the successful National Coop- erative Highway Research Program (NCHRP), undertakes research and other technical activities in response to the needs of transit ser- vice providers. The scope of TCRP includes various transit research fields including planning, service configuration, equipment, facilities, operations, human resources, maintenance, policy, and administrative practices. TCRP was established under FTA sponsorship in July 1992. Proposed by the U.S. Department of Transportation, TCRP was authorized as part of the Intermodal Surface Transportation Efficiency Act of 1991 (ISTEA). On May 13, 1992, a memorandum agreement outlining TCRP operating procedures was executed by the three cooperating organi- zations: FTA; the National Academies of Sciences, Engineering, and Medicine, acting through the Transportation Research Board (TRB); and the Transit Development Corporation, Inc. (TDC), a nonprofit educational and research organization established by APTA. TDC is responsible for forming the independent governing board, designated as the TCRP Oversight and Project Selection (TOPS) Commission. Research problem statements for TCRP are solicited periodically but may be submitted to TRB by anyone at any time. It is the responsibility of the TOPS Commission to formulate the research program by identi- fying the highest priority projects. As part of the evaluation, the TOPS Commission defines funding levels and expected products. Once selected, each project is assigned to an expert panel appointed by TRB. The panels prepare project statements (requests for propos- als), select contractors, and provide technical guidance and counsel throughout the life of the project. The process for developing research problem statements and selecting research agencies has been used by TRB in managing cooperative research programs since 1962. As in other TRB activities, TCRP project panels serve voluntarily without compensation. Because research cannot have the desired effect if products fail to reach the intended audience, special emphasis is placed on disseminat- ing TCRP results to the intended users of the research: transit agen- cies, service providers, and suppliers. TRB provides a series of research reports, syntheses of transit practice, and other supporting material developed by TCRP research. APTA will arrange for workshops, train- ing aids, field visits, and other activities to ensure that results are imple- mented by urban and rural transit industry practitioners. TCRP provides a forum where transit agencies can cooperatively address common operational problems. TCRP results support and complement other ongoing transit research and training programs. Published research reports of the TRANSIT COOPERATIVE RESEARCH PROGRAM are available from Transportation Research Board Business Office 500 Fifth Street, NW Washington, DC 20001 and can be ordered through the Internet by going to https://www.nationalacademies.org and then searching for TRB Printed in the United States of America
The National Academy of Sciences was established in 1863 by an Act of Congress, signed by President Lincoln, as a private, non- governmental institution to advise the nation on issues related to science and technology. Members are elected by their peers for outstanding contributions to research. Dr. Marcia McNutt is president. The National Academy of Engineering was established in 1964 under the charter of the National Academy of Sciences to bring the practices of engineering to advising the nation. Members are elected by their peers for extraordinary contributions to engineering. Dr. John L. Anderson is president. The National Academy of Medicine (formerly the Institute of Medicine) was established in 1970 under the charter of the National Academy of Sciences to advise the nation on medical and health issues. Members are elected by their peers for distinguished contributions to medicine and health. Dr. Victor J. Dzau is president. The three Academies work together as the National Academies of Sciences, Engineering, and Medicine to provide independent, objective analysis and advice to the nation and conduct other activities to solve complex problems and inform public policy decisions. The National Academies also encourage education and research, recognize outstanding contributions to knowledge, and increase public understanding in matters of science, engineering, and medicine. Learn more about the National Academies of Sciences, Engineering, and Medicine at www.nationalacademies.org. The Transportation Research Board is one of seven major programs of the National Academies of Sciences, Engineering, and Medicine. The mission of the Transportation Research Board is to provide leadership in transportation improvements and innovation through trusted, timely, impartial, and evidence-based information exchange, research, and advice regarding all modes of transportation. The Boardâs varied activities annually engage about 8,000 engineers, scientists, and other transportation researchers and practitioners from the public and private sectors and academia, all of whom contribute their expertise in the public interest. The program is supported by state transportation departments, federal agencies including the component administrations of the U.S. Department of Transportation, and other organizations and individuals interested in the development of transportation. Learn more about the Transportation Research Board at www.TRB.org.
C O O P E R A T I V E R E S E A R C H P R O G R A M S CRP STAFF FOR TCRP RESEARCH REPORT 223 Christopher J. Hedges, Director, Cooperative Research Programs Lori L. Sundstrom, Deputy Director, Cooperative Research Programs Gwen Chisholm Smith, Manager, Transit Cooperative Research Program Dianne S. Schwager, Senior Program Officer Jarrel McAfee, Senior Program Assistant Eileen P. Delaney, Director of Publications Natalie Barnes, Associate Director of Publications TCRP PROJECT H-55 PANEL Field of Policy and Planning Harmony Lloyd, Flint Mass Transportation Authority, Flint, MI (Chair) A. Jeff Becker, Regional Transportation District (Denver), Denver, CO Flora M. Castillo, Pivot Strategies, LLC, Ventnor, NJ Charlotte A. Frei, CDM Smith, Chicago, IL Heidi Guenin, Trillium Solutions, Portland, OR Valerie Lefler, Feonix Mobility Rising, Lincoln, NE Karin A. Morris, Delaware Valley Regional Planning Commission, Philadelphia, PA John P. Lynch, FTA Liaison Danielle Nelson, FTA Liaison Amy Conrick, CTAA Liaison Virginia L. Dize, National Association of Area Agencies on Aging Liaison Wendy Heaps, Centers for Disease Control and Prevention Liaison Tia-Nicole Leak, Health Resources and Services Administration Liaison Paul Perry, Department of Veterans Affairs Liaison Robin Riesa Phillips, National Rural Transit Assistance Program Liaison Danny Drees, American Public Transportation Association Liaison Richard A. Weaver, American Public Transportation Association Liaison Stephen J. Andrle, TRB Liaison AUTHOR ACKNOWLEDGMENTS The research conducted for this guidebook was performed by the KFH Group, Inc. (KFH Group) with assistance from NORC at the University of Chicago. Ken Hosen of the KFH Group was the Principal Investigator and a primary author of the guidebook. Ms. Elizabeth (Buffy) Ellis of the KFH Group was the Co-Principal Investigator and also a primary author. Beth Hamby and Ridhima Mehrotra of the KFH Group provided a wide range of support in conducting surveys and identifying collaborative practices as well as in formatting the document. Luciana Rocha with NORC at the University of Chicago conducted research and contributed significantly to the guidebook. Alana Knudsen, also of NORC, provided support. Thanks goes to Southwest Transit Association, the National Rural Transit Assistance Program, a number of state departments of transportation, and health-care organizations for their support in identifying the case studies and collaborative practices. We also sincerely thank the many transit organizations and health-care providers that responded to our queries and agreed to be the subject of case studies and collaborative practices. Their insights, data, and willingness to share their experiences enriched the research teamâs efforts.
TCRP Research Report 223 provides a guidebook to help communities improve trans- portation to health care and a research plan to address the continuing need to under- stand how community partnerships between the health-care and transportation sectors develop and can be encouraged. The guidebook provides useful strategies and resources for three important audiencesâhealth care, transportation, and other stakeholdersâto build effective relationships to improve customer-focused mobility services to health-care services. The availability of transportation influences the ability of individuals to access health care, whether in urban, suburban, or rural areas. Those lacking transportation often miss health- care appointments, resulting in delays in receiving medical interventions, which can then lead to poorer health outcomes. This in turn contributes to the rising cost of health care. Research has found that access to reliable and affordable transportation is associated with increased utilization of health services and improved health outcomes; improved access to health care will provide for greater patient encounters and reduce no-show rates; and readily-available transportation can prevent extra stays in the hospital and generate overall cost-savings. Successful collaborations to improve patient access to health-care services have emerged in communities across the United States. An understanding of these collaborations may benefit other communities interested in improving transportation access to health care. However, the complexities intrinsic to the transportation and health-care sectors make collaboration between the sectors challenging. To assist in overcoming these challenges, TCRP Project H-55, âGuidebook and Research Plan to Help Communities Improve Transportation to Health-Care Servicesâ was conducted to develop 1) a guidebook that discusses the solutions that have integrated the health-care and transportation sectors and have helped improve transportation to health care, and 2) a research plan that outlines future research priorities. KFH Group, Inc., in association with NORC at the University of Chicago, conducted a literature review followed by surveys of providers of transportation as well as of health care and social services to learn about their efforts to improve access to health care. This led to further research of transportation and health-care relationships. Successful pro- grams and partnerships identified through the research were documented and described in the guidebook either as detailed case studies or as collaborative practices. F O R E W O R D By Dianne S. Schwager Staff Officer Transportation Research Board
C O N T E N T S 1 Summary 6 Chapter 1 Introduction to the Guidebook 6 It Takes a Community 7 Objectives and Products of the Research Project 7 What Is in the Guidebook? 8 How to Use the Guidebook 9 Chapter 2 Why Should Communities Improve Transportation to Health Care? 9 Introduction 9 Transportation: A Social Determinant of Health 11 The Need for Transportation to Health Care 12 Transportation Barriers: A Factor Affecting Health-Care Disparities 14 Issues Facing Health-Care Providers in Improving Access to Health Care 17 The Business Case for Improving Transportation Access to Health Care 19 What Can Communities Do to Improve Transportation to Health Care? 20 Summary 20 Chapter Notes 23 Chapter 3 Working Toward a Partnership: Health Care and Transportation 23 Introduction 24 Common Factors Affecting Transportation to Health Care 26 Why Should the Health-Care and Transportation Sectors Communicate and Collaborate? 28 Who Are Potential Health-Care and Transportation Participants? 34 What Are the Specific Transportation Needs? 39 Start the Dialogue 40 Develop a Shared Goal 41 Possible Barriers to Collaboration 41 Resources for Addressing Potential Barriers 51 Chapter Notes 53 Chapter 4 Develop Transportation Solutions 53 Introduction 54 Understanding the Basics of Transportation: What Health Care Providers Need to Know 68 Understanding Mobility Limitations of Riders One Patient at a Time 69 Transportation Solutions and Service Design: One Size Does Not Fit All 78 Sustainability: Building a Strong Transportation Support Network 83 Chapter Notes
84 Chapter 5 Case Studies 84 Introduction 85 Case Studies 86 Mobility ManagementâImproving Access to Health Care in Central Texas: Capital Metro Transportation Authority and Capital Area Rural Transportation System 93 Attachments to Case Study of Capital Metro and CARTS Office of Mobility Management for Central Texas 94 Coordinating Patient Transportation to Improve Access to Health Care: Denver Health Medical Center 97 Same-Day Trips for Medical and Wellness-Related Appointments: Flint MTAâs Rides to Wellness 104 Coordinating Public Transit, Human Service, and Medicaid Transportation: Lane Transit Districtâs RideSource 111 Attachments to Case Study of Lane Transit Districtâs RideSource 114 Building Transportation Options and Solutions for Rural Missourians: Missouri Rural Health Associationâs HealthTran 120 Chapter Notes 121 Chapter 6 Collaborative Practices 121 Introduction 122 Collaborative Practices 122 Health-Care Provider Operates Rural Public Transit to Improve Patient Access in Rural Mississippi: Aaron E. Henry Community Health Services Center, Inc. 125 Health Care Insurer Offers Free NEMT Transportation: CareMore Health System 128 NEMT Provided by a Health Care Consortium in Columbia County, New York: Children and Adults Rural Transportation Service (CARTS) 131 County Demand Response Program Partners with Local Hospitals for Funding Support in Baltimore County, Maryland: CountyRide 133 Transportation Pilot in Central Pennsylvania to Improve Patient Access to Health Care and Reduce No-Shows: Geisinger Health Systemâs Partnership with rabbittransit 135 Logistics Platform Connecting Transportation and Health Care: Kaizen Health 138 Health Care Transportation and Ride Hailing: Lyft 139 Service Design Matters: North Central Regional Transit District, New Mexico 141 Transit SponsorshipâA New Sustainability Model in Paris, Texas: Paris Metro 144 Healthy Hop: Pinellas Suncoast Transit Authority 146 A Call Center Increasing Access to Health Care in Southern Illinois: Rides Plus 148 Accountable Care Organization in the Rio Grande Valley, Texas: Rio Grande Valley Health Alliance 150 Fixed-Schedule Service Improves Access to Health Care in Western North Carolina: Rutherford County Transit 154 Free Van Service Operated by a Hospital in Central Kentucky: Taylor Regional Hospital 156 Health Care Transportation and Ride Hailing: Uber Health 157 Brokering Medicaid NEMT: Vermont Public Transportation Association 159 Types of Practice 176 Chapter Notes 177 Appendix Research Plan