Non-Emergency Medical Transportation Needs of Middle-Aged and Older Adults: A Rural-Urban Comparison in Delaware, USA.

Background: Older adults in rural areas have unique transportation barriers to accessing medical care, which include a lack of mass transit options and considerable distances to health-related services. This study contrasts non-emergency medical transportation (NEMT) service utilization patterns and associated costs for Medicaid middle-aged and older adults in rural versus urban areas. Methods: Data were analyzed from 39,194 NEMT users of LogistiCare-brokered services in Delaware residing in rural (68.3%) and urban (30.9%) areas. Multivariable logistic analyses compared trip characteristics by rurality designation. Results: Rural (37.2%) and urban (41.2%) participants used services more frequently for dialysis than for any other medical concern. Older age and personal accompaniment were more common and wheel chair use was less common for rural trips. The mean cost per trip was greater for rural users (difference of $2910 per trip), which was attributed to the greater distance per trip in rural areas. Conclusions: Among a sample who were eligible for subsidized NEMT and who utilized this service, rural trips tended to be longer and, therefore, higher in cost. Over 50% of trips were made for dialysis highlighting the need to address prevention and, potentially, health service improvements for rural dialysis patients

Measures of organizational characteristics associated with adoption and/or implementation of innovations: A systematic review

Abstract Background This paper identifies and describes measures of constructs relevant to the adoption or implementation of innovations (i.e., new policies, programs or practices) at the organizational-level. This work is intended to advance the field of dissemination and implementation research by aiding scientists in the identification of existing measures and highlighting methodological issues that require additional attention. Methods We searched for published studies (1973–2013) in 11 bibliographic databases for quantitative, empirical studies that presented outcome data related to adoption and/or implementation of an innovation. Included studies had to assess latent constructs related to the “inner setting” of the organization, as defined by the Consolidated Framework for Implementation Research. Results Of the 76 studies included, most (86%) were cross sectional and nearly half (49%) were conducted in health care settings. Nearly half (46%) involved implementation of evidence-based or “best practice” strategies; roughly a quarter (26%) examined use of new technologies. Primary outcomes most often assessed were innovation implementation (57%) and adoption (34%); while 4% of included studies assessed both outcomes. There was wide variability in conceptual and operational definitions of organizational constructs. The two most frequently assessed constructs included “organizational climate” and “readiness for implementation.” More than half (55%) of the studies did not articulate an organizational theory or conceptual framework guiding the inquiry; about a third (34%) referenced Diffusion of Innovations theory. Overall, only 46% of articles reported psychometric properties of measures assessing latent organizational characteristics. Of these, 94% (33/35) described reliability and 71% (25/35) reported on validity. Conclusions The lack of clarity associated with construct definitions, inconsistent use of theory, absence of standardized reporting criteria for implementation research, and the fact that few measures have demonstrated reliability or validity were among the limitations highlighted in our review. Given these findings, we recommend that increased attention be devoted toward the development or refinement of measures using common psychometric standards. In addition, there is a need for measure development and testing across diverse settings, among diverse population samples, and for a variety of types of innovations

Socioeconomic, Geospatial, and Geopolitical Disparities in Access to Health Care in the US 2011–2015

Individuals forgoing needed medical care due to barriers associated with cost are at risk of missing needed care that may be necessary for the prevention or maintenance of a chronic condition among other things. Thus, continued monitoring of factors associated with forgone medical care, especially among vulnerable populations, is critical. National survey data (2011–2015) for non-institutionalized adults residing in the USA were utilized to assess forgone medical care, defined as not seeking medical care when the individual thought it was necessary because of cost in the past 12 months. Logistic regression was used to predict forgone medical care vs. sought medical care. Racial/ethnic minority working-age adults, those with lower incomes, those with lower educations, those residing in the South, and those residing in states that failed to participate in Medicaid Expansion in 2014 were more likely (p < 0.01) to forgo medical care due to cost in the past year. Policy makers seeking to reduce barriers to forgone medical care can use this information to tailor their efforts (e.g., mechanisms targeted to bridge gaps in access to care) to those most at-risk and to consider state-level policy decisions that may impact access to care

Preferred health information sources: An examination of vulnerable middle-aged and older women

Background. Women are the greatest consumers of health information. Despite this fact, little is known about middle-aged and older women’s preferred sources for health information. Objectives. This study aims to: (1) identify preferred sources of health-related information among middle-aged and older women; and (2) examine sociodemographics, family/household characteristics, health status, and health-related behaviors associated with their preferred sources for health information. Methods. Data were collected from 3,946 middle-age and older women using a randomized multimodal survey of households in an eight-county region of Texas. Frequencies, Pearson’s chi-squares and one-way ANOVA were used to examine relationships to the respondent’s preferred sources of health information and assess differences among variables. Multinomial logistic regression was performed to compare factors associated with participants’ preferred source of receiving health-related messages. Results. Most participants preferred receiving health information from healthcare providers (62.7%), followed by the internet (13.5%), mass media (12.2%), and family/friends (11.6%). Women who were older, Non-Hispanic/Latino African American, living in rural areas, who had more chronic conditions, who were overweight or obese, and had consulted a doctor in the past 12 months were significantly less likely to prefer internet-based health messages to receiving health information from healthcare providers. In contrast, participants residing with children ages 5 years and younger were more likely to prefer receiving health information from family and friends than from healthcare providers. Conclusion: Although provider-patient communication was preferred, a variety of channels may be needed to disseminate accurate and reliable health messages to middle-aged and older women

Assessing The Economic Benefits And Resilience Of Complete Streets In Orlando, Fl: A Natural Experimental Design Approach

Complete Streets are designed to allow for safe access and use for all (e.g., pedestrians, bicyclists, transit commuters, motorists) to improve mobility and accessibility. Retrofitting Complete Street designs acts as an intervention by increasing active transportation activity and providing safety benefits (e.g., reducing motor vehicle involved crashes and injuries); however there is insufficient evidence related to economic benefits of this redesign. This study applied a natural experiment design to: (1) explore the economic benefits on single-family (SF) property value appreciation before-and-after the implementation of the Complete Street during the housing market boom (from 2000 to 2007), and (2) examine the economic resilience of Complete Street designs on maintaining SF property values during the housing market crash (from 2007 to 2011) at Edgewater Dr. in Orlando, FL. Propensity score matching was used to match intervention and control residences with similar building attributes. On average, SF homes exposed to Complete Streets had 8.2% and 4.3% higher home value appreciation and home value resilience than their counterparts in the adjacent non-exposed control area during housing market boom and recession, respectively. Further, on average, SF homes exposed to Complete Streets experienced relatively higher, at 2.7% and 1.6%, home value appreciation and home value resilience than their control counterparts around the nonadjacent auto-oriented control roads during housing market boom and recession, respectively. The implications of this study can inform local planning practice providing evidence that Complete Streets perform better than conventional street designs on maintaining a ‘healthy’ housing market in both economic boom and recession. The economic benefits found can be integrated with research that demonstrates public health and safety benefits of Complete Streets to address the current barriers in implementing Complete Streets and support for policies facilitating the implementation of Complete Streets nationally