Table 1.

Studies reporting interventions to improve transportation to chronic care management

Author & publication year	Sample & recruitment setting	Methods	Transportation intervention (Interventionist)	Additional intervention components	Main findings
Esperat et al., 2012	N = 152 adults with diabetes, hypertension, asthma, co-morbidities of obesity, and depression Federally-qualified nurse-managed health center (Texas, USA)	Quasi-experimental pre-post	Guidance on how to purchase bus passes (Community health worker [promotora])	Home visits, phone calls, motivational interviewing, self-care goal setting, social support assessments	Average HbA1c, blood pressure, HDL, and LDL decreased Triglycerides increased Chronic disease management and diabetes self-efficacy improved
Kaplan et al., 2000	N = 4488 females with abnormal pap smear, 92% Hispanic Urban hospitals, public health centers, comprehensive health centers, (Los Angeles, CA, USA)	Quasi-experimental Before-after nonequival ent control group	Free mailed bus passes for 2 round-trip fares for follow-up care (Research staff including nurses)	Tracking follow-up protocol including personal letter and informational brochures, phone calls, financial incentives to return for follow-up	Intervention group had 5.4% higher follow-up rate in year 2 (p<.05), 9.1% higher in year 4 (p<.05), and 4.5% higher years 2–4 (p<.0001) Control group had higher follow-up rate in year 3 at the CHC sites (p<.05)
Kotwani et al., 2014	N = 214 hypertensive adults, 47% female, 32% no education Rural community health campaign (Southwest Uganda)	Quasi-experimental	Transport voucher reimbursable for cost of a one-way journey to health center (Nurse)	Individual education/counselin g session and referral appointment to nearest local health facility or regional hospital	83% linked to care within 6 months; median time to link 22 days Age >60 years more likely to link than age 18–29 years Higher education more likely to link to care Men less likely than women to link to care Those referred to local health center more likely to go compared to referred to regional hospital
Krieger et al., 1999	N = 421 adults with elevated blood pressure and income <200% federal poverty level, 72% male, 79% Black/African American, 40% uninsured, 24% less than high school education Public spaces in urban low-income neighborhoods (Seattle, WA, USA)	Randomized controlled trial	Referral to community transportation (Community health worker)	Referral to medical care, assistance scheduling medical appointment, appointment reminder letter, post-appointment follow-up, referral to services to reduce barriers to care	Intervention group had 39% higher follow-up rate to medical care than control (p=0.001)
Marcus et al., 1992	N=2044 low-income women with abnormal pap smear, 69% minority non-white, 44% less than high school education, 69% no insurance Urban/suburban primary health care clinics (Los Angeles, CA, USA)	Randomized controlled trial	Bus tickets mailed with letter that follow-up care is needed; passes for two one-way fares, two express bus supplemental fares, and five transfers ($2.00-$2.90 total); option of $2.00 parking permit (Clinic staff)	Personalized follow-up letter and educational pamphlet, a slide-tape program on pap smears	Transportation incentives (OR = 1.48, p<.05) and the combined intervention with personalized follow-up and slide-tape program (OR 2.3, p<.01) both improved screening follow-up rate Transportation incentives alone improved return rates among county patients (OR: 1.51; p<.05), more severe pap smear results (OR 1.71; p<.05) and noninsured patients (OR: 1.77; p<.01).
Niccols et al., 2005	N = 13 mothers age 21–36 with substance use disorder and their children (0–6 years), 85% low SES, 69% involved with child protection agency Central site (Hamilton, Ontario, Canada)	Quasi-experimental Pilot pre-post	Bus tickets provided (Staff members)	Program 2 days/week with individual and group addictions counseling, nutrition counseling and grocery vouchers, skill development, parenting education and counseling, peer support, children’s programming Linkage to family medical services, home nurse visits, developmental services	Maternal empathy improved at 3 months (p<0.05) Child’s social competence improved at 6 months (p<0.05) No significant change in substance use, use of health and childcare services, social support, or diet
Percac-Lima et al., 2009	N = 1223 low-income, ethnically diverse adults 52–79 years old overdue for colorectal cancer screening, 59% female, 34% Spanish-speaking, 29% government insurance Urban primary clinics and community health centers (Boston, MA, USA)	Randomized controlled trial	Free shuttle provided to hospital for colorectal cancer screening appointments, or taxi vouchers to get home (Patient navigators)	Letter with educational material, phone or in-person patient education to overcome barriers to screening, procedure scheduling, translation, insurance support	Intervention more likely to undergo screening (15%) and colonoscopy (11%) than control (p<0.001). Effective in all patient subgroups regardless of gender, language, race/ethnicity, or insurance status.
Taylor et al., 1999	N = 314 women age 50–74 due for mammography, 39% Black/African American, 66% Medicaid/Medicare Inner-city primary care clinic (Seattle, WA, USA)	Randomized controlled trial	Bus passes provided to attend mammography appointments (Nurse)	Nursing care coordination, video and printed patient education, appointment reminder phone calls and postcards, rescheduling assistance, provider education, provider computer prompts	Intervention improved mammograph y completion in 8 weeks by 27% (p<0.001). Only 4% of participants (n = 6) accepted bus passes
Taylor et al., 2002	N = 482 Chinese women under-utilizing pap testing, 57% less than high school education, 3% English speaking, 54% lived in North America <25 years Urban (Seattle, WA, USA and Vancouver, BC, Canada)	Randomized controlled trial	Taxi transportation to and from clinic appointments or two bus passes (Outreach worker)	Education-entertainment video, motivational pamphlet, educational brochure, fact sheet, tailored counseling and logistic assistance	Intervention group more likely to report pap testing in 6 months than control (p<0.001) Few participants accepted transportation assistance
Tierney et al., 2000	N = 23,707 (1994) compared to N = 23,015 (1993) Medicaid patients, 66% female, 60% Black/African American Urban inner-city public hospital (Indiana, USA)	Cohort study Historical comparison	Automatic reimbursement for <10 round trips to medical care per year, with prior authorization required for >9 trips (Medicaid policy change)	None	Primary care visits declined 16% (p<0.001) Neighborhood health center visits increased 7% (p<0.001) Emergency and urgent visits decreased 8% (p<0.001) Medication refill visits decreased 18% (p<0.001) Blood pressure increased (systolic p=0.01; diastolic p=0.003) Visits for reactive airway disease decreased (p<0.001)

Note: CHC = comprehensive health center; HbA1c = hemoglobin A1c; OR = odds ratio