The Impact of Rideshare Transportation Services on Appointment Adherence

Study Overview
=================
Brief Summary
-----------------
This study is a prospective clinical trial designed to primarily test the impact of rideshare-based transportation services from a digital transportation network, Lyft, on reducing primary care clinic missed appointments--a composite outcome of no-shows and same day cancellations--for Medicaid patients. The study population consists of West Philadelphia residents who are established patients at two of the Penn Medicine Primary Care Practices within the University of Pennsylvania Health System. The study subjects are allocated into the intervention or control arm using a pseudorandomization approach - those receiving an appointment reminder on an even calendar day are in the intervention arm and odd calendar day calls are in the control arm. Secondary outcomes include the time of arrival to the clinics relative to actual appointment time (both arms), prospective utilization of acute care settings (both arms), prospective utilization of primary care (both arms), and description of programmatic metrics in the intervention arm (travel time, misuse, and costs). The investigators will assess the patient experience after each ride using a telephone-based survey and in-depth interviews. All adults with established primary care at the Penn Medicine Clinics, who have Medicaid, and do not require wheelchair accessible rides will be eligible for the rideshare service. The investigators hypothesize that individuals offered a rideshare-based transportation service will have a decreased proportion of missed appointments and same day cancellations as those not offered the service.

Conditions
-----------------
Appointments and Schedules, Social Determinants of Health, Transportation, Primary Health Care

Intervention / Treatment
-----------------
* Other: Rideshare-based transportation


Participation Criteria
=================
Eligibility Criteria
-----------------
Inclusion Criteria: Patients insured by Medicaid Established primary care patient at the Penn Medicine Clinics Address in West Philadelphia zip code Exclusion Criteria: Requiring wheelchair accessible transportation. We are unable to guarantee vehicles that will be able to accommodate these patients' physical needs.

Ages Eligible for Study
-----------------
Minimum Age: 18 Years

Sexes Eligible for Study
-----------------
All

Accepts Healthy Volunteers
-----------------
Accepts Healthy Volunteers

Study Plan
=================
How is the study designed?
-----------------

Design Details

Primary Purpose: Health Services Research
Allocation: Non-Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Rideshare<br>The intervention arm will receive an appointment reminder and free transportation for one appointment to travel between the patient's home and primary care clinic using a rideshare-based transportation service. | Other: Rideshare-based transportation<br> <br> * Other names: Lyft;|
| No Intervention: Control<br>The control arm will receive an appointment reminder, but no free transportation offer. | |

What is the study measuring?
-----------------
Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| The proportion of missed appointments (no-shows and same-day cancellation) in the intervention arm and the control arm | The missed appointment proportion is based on the one appointment for which patients were contacted to receive a free ride | Within 2 days of enrollment | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Arrival time to clinic relative to the scheduled time (both arms) |  | Within 2 days of enrollment | 
| Post-intervention, utilization frequency of acute care settings (both arms) |  | 7-days, 30-days, and 6 months post-appointment | 
| Post-intervention, utilization frequency of primary care (both arms) |  | 7-days, 30-days, and 6 months post-appointment | 
| Post-intervention, frequency of missed primary care appointments (both arms) |  | 30-days and 6-months post-appointment | 

 Terms related to the study
=================
Keywords Provided by Centre Hospitalier Valida
-----------------
Rideshare, Digital transportation network, Missed appointment