Addressing Transportation Insecurity Improves Attendance at Posthospitalization Appointments

Authors

Sarah C. Hoffman, The Barbara Bush Children's Hospital at Maine Medical Center, Portland, Maine.
Amy S. Buczkowski, The Barbara Bush Children's Hospital at Maine Medical Center, Portland, Maine.
Leah Mallory, The Barbara Bush Children's Hospital at Maine Medical Center, Portland, Maine.
Lauren B. McGovern, The Barbara Bush Children's Hospital at Maine Medical Center, Portland, Maine.
Shannon M. Cappen, The Barbara Bush Children's Hospital at Maine Medical Center, Portland, Maine.
Amy S. Douglass, The Barbara Bush Children's Hospital at Maine Medical Center, Portland, Maine.
Russell Correia, The Barbara Bush Children's Hospital at Maine Medical Center, Portland, Maine.
Lee Longnecker, The Barbara Bush Children's Hospital at Maine Medical Center, Portland, Maine.
Campbell S. Taylor, The Barbara Bush Children's Hospital at Maine Medical Center, Portland, Maine.
Rebekah Holmes, The Barbara Bush Children's Hospital at Maine Medical Center, Portland, Maine.
Brogan Poulin, The Barbara Bush Children's Hospital at Maine Medical Center, Portland, Maine.
Lorraine L. McElwain, The Barbara Bush Children's Hospital at Maine Medical Center, Portland, Maine.

Document Type

Article

Publication Date

1-1-2022

Institution/Department

Pediatrics

Journal Title

Pediatrics

MeSH Headings

Aftercare (organization & administration, standards); Appointments and Schedules; Checklist; Hospitals, Pediatric (organization & administration, standards); Humans; Maine; Patient Discharge (standards); Quality Improvement; Transportation

Abstract

BACKGROUND: Transportation influences attendance at posthospitalization appointments (PHAs). In 2017, our pediatric hospital medicine group found that our patients missed 38% of their scheduled PHAs, with several being due to transportation insecurity. To address this, we implemented a quality improvement project to perform inpatient assessment of transportation insecurity and provide mitigation with the goal of improving attendance at PHAs. METHODS: The process measure was the percentage of patients with completed transportation insecurity screening, and the outcome measure was PHA attendance. An interprofessional team performed plan-do-study-act cycles. These included educating staff about the significance of transportation insecurity, its assessment, and documentation; embedding a list of local transportation resources in discharge instructions and coaching families on using these resources; notifying primary care providers of families with transportation insecurity; and auditing PHA attendance. RESULTS: Between July 2018 and December 2019, electronic health record documentation of transportation insecurity assessment among patients on the pediatric hospital medicine service and discharged from the hospital (n = 1731) increased from 1% to 94%, families identified with transportation insecurity increased from 1.2% to 5%, and attendance at PHAs improved for all patients (62%-81%) and for those with transportation insecurity (0%-57%). Our balance measure, proportion of discharges by 2 pm, remained steady at 53%. Plan-do-study-act cycles revealed that emphasizing PHA importance, educating staff about transportation insecurity, and helping families identify and learn to use transportation resources all contributed to improvement. CONCLUSIONS: Interventions implemented during the inpatient stay to assess for and mitigate transportation insecurity led to improvement in pediatric PHA attendance.

Recommended Citation

McCarthy SS, Karolak M, Oxburgh L. Smad4 controls proliferation of interstitial cells in the neonatal kidney. Development. 2022;149(1):dev199984. doi:10.1242/dev.199984