ACTiN: Improving Transportation Assets and the Effects on Wellness Metrics
Study Details
Study Description
Brief Summary
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Implementation of an Advanced Connected Transportation Network (ACTiN), a novel, collaborative multinetwork transportation model for small cities and rural areas.
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Evaluation of effectiveness in improving transportation assets for clients of a community-based nonprofit specializing in addressing social determinants of health (Lighthouse Community Health Services in Lynchburg, VA).
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Simultaneous evaluation of wellness metrics based on the standards of the CMS Annual Wellness Visit and metrics associated with common chronic diseases.
| Condition or Disease | Intervention/Treatment | Phase |
|---|---|---|
|
N/A |
Detailed Description
- Implementation of a community transportation solution The project will be managed by Unified Potential, Inc., a 501c3 tax-exempt organization for transportation.
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The solution requires implementation of four separate transportation "networks"
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Public / Contracted / For-Hire Transportation
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Workforce Transportation Network
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Community Rideshare Network
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Volunteer Transportation Network
- Assessment of Personal Transportation Assets
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Subjects asked to complete a survey upon intake, at six months, and at one year
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Digital survey:
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Can be completed by individual using provided smartphone app or at onsite desktop kiosk
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Can be facilitated by a caregiver or other provider not involved in data analysis
- Assessment of health and wellness metrics and chronic disease metrics if applicable
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Dataset based on metrics assessed in the Center for Medicare and Medicaid Services (CMS) Annual Wellness Visit
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All metrics quantified via either binary (yes/no) or through use of a validated scale (see below)
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Data collected electronically at onsite or in-home provider visits at intake, six months, and one year
Study Design
Arms and Interventions
| Arm | Intervention/Treatment |
|---|---|
| Experimental: Study arm Low resource, high risk individuals with limited transportation options as a social determinant of health. |
Behavioral: Transportation service
Improved transportation assets applied to all aspects of subjects life
|
Outcome Measures
Primary Outcome Measures
- Rides completed [1 year]
Total number of rides for test subject per week, averaged over previous 6 months, measured at intake, 6 months, and 1 year.
- Cost of transportation [1 year]
Total cost per mile of transportation, averaged over previous 6 months, measured at intake, 6 months, and 1 year.
- Untreated disease(s) [1 year]
Total number of attributed disease diagnoses that are not being treated, measured at intake, 6 months, and 1 year.
- Cancer screening success [1 year]
Number of eligible cancer screening exams not performed (lung, colon, breast), measured at intake, 6 months, and 1 year.
Secondary Outcome Measures
- Unmet transportation needs [1 year]
Total number of rides per week that test subject is unable to complete, averaged over 6 previous 6 months, measured at intake, 6 months, and 1 year.
- Unmet medical transportation needs [1 year]
Total number of medical (including mental health) appointments missed due to transportation, averaged over previous 6 months, measured at intake, 6 months, and 1 year.
- Prescribed medications [1 year]
Total number of prescribed medications, measured at intake, 6 months, and 1 year.
- Prescribed medications not utilized [1 year]
Total number of prescribed medications that are not being utilized (all cause), averaged over previous 6 months, measured at intake, 6 months, and 1 year.
- Weight [1 year]
Weight in pounds, measured at intake, 6 months, and 1 year.
- BMI [1 year]
Body mass index, measured at intake, 6 months, and 1 year.
- Blood Pressure [1 year]
Blood Pressure (mmHg), measured at intake, 6 months, and 1 year.
- Hgb A1c [1 year]
Hemoglobin A1c, measured at intake, 6 months, and 1 year.
- ADL [1 year]
Activities of daily living (Barthel index), measured at intake, 6 months, and 1 year.
- IADL [1 year]
Instrumental activities of daily living (Lawton scale), measured at intake, 6 months, and 1 year.
- Physical activity [1 year]
Physical activity / exercise assessment (Modified Kaiser physical activity survey), measured at intake, 6 months, and 1 year.
- Psychosocial assessment [1 year]
Psychosocial assessment (PAT, Briggs Health), measured at intake, 6 months, and 1 year.
- Cognitive function [1 year]
Cognitive function test (CPCOG), measured at intake, 6 months, and 1 year.
- Depression screening [1 year]
Depression screening and/or assessment (MHA depression screening tool), measured at intake, 6 months, and 1 year.
- Other mental health conditions [1 year]
Other mental health conditions (MHA screening and assessment tools), measured at intake, 6 months, and 1 year.
- Smoking assessment [1 year]
Smoking / tobacco / nicotine use (No/Yes, with yes triggering LDCT assessment), measured at intake, 6 months, and 1 year.
- Substance use [1 year]
Substance use or abuse (CAGE), measured at intake, 6 months, and 1 year.
Eligibility Criteria
Criteria
Inclusion Criteria:
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Adult resident of the City of Lynchburg, Virginia
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Under-resourced at trial entry as defined by meeting eligibility for welfare, food stamps/SNAP, Medicaid, Housing Choice Voucher program, or income at or below 200% of the Federal Poverty Threshold.
Exclusion Criteria:
- None
Contacts and Locations
Locations
| Site | City | State | Country | Postal Code | |
|---|---|---|---|---|---|
| 1 | Lighthouse Community Health Center | Lynchburg | Virginia | United States | 24504 |
Sponsors and Collaborators
- John M. Salmon IV, MD
Investigators
- Study Director: John Salmon, MD, Medical Director, Lighthouse Community Health Center
Study Documents (Full-Text)
None provided.More Information
Additional Information:
Publications
- Bradley EH, Elkins BR, Herrin J, Elbel B. Health and social services expenditures: associations with health outcomes. BMJ Qual Saf. 2011 Oct;20(10):826-31. doi: 10.1136/bmjqs.2010.048363. Epub 2011 Mar 29.
- Hood CM, Gennuso KP, Swain GR, Catlin BB. County Health Rankings: Relationships Between Determinant Factors and Health Outcomes. Am J Prev Med. 2016 Feb;50(2):129-35. doi: 10.1016/j.amepre.2015.08.024. Epub 2015 Oct 31.
- Solberg LI. Theory vs Practice: Should Primary Care Practice Take on Social Determinants of Health Now? No. Ann Fam Med. 2016 Mar;14(2):102-3. doi: 10.1370/afm.1918.
- 4212.081022