1. Implementation of an Advanced Connected Transportation Network (ACTiN), a novel, collaborative multinetwork transportation model for small cities and rural areas. 2. 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). 3. Simultaneous evaluation of wellness metrics based on the standards of the CMS Annual Wellness Visit and metrics associated with common chronic diseases.
1. Implementation of a community transportation solution The project will be managed by Unified Potential, Inc., a 501c3 tax-exempt organization for transportation. * The solution requires implementation of four separate transportation "networks" * Public / Contracted / For-Hire Transportation * Workforce Transportation Network * Community Rideshare Network * Volunteer Transportation Network 2. Assessment of Personal Transportation Assets * Subjects asked to complete a survey upon intake, at six months, and at one year * Digital survey: * Can be completed by individual using provided smartphone app or at onsite desktop kiosk * Can be facilitated by a caregiver or other provider not involved in data analysis 3. Assessment of health and wellness metrics and chronic disease metrics if applicable * Dataset based on metrics assessed in the Center for Medicare and Medicaid Services (CMS) Annual Wellness Visit * All metrics quantified via either binary (yes/no) or through use of a validated scale (see below) * Data collected electronically at onsite or in-home provider visits at intake, six months, and one year
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
OTHER
Masking
NONE
Enrollment
50
Improved transportation assets applied to all aspects of subjects life
Lighthouse Community Health Center
Lynchburg, Virginia, United States
Rides completed
Total number of rides for test subject per week, averaged over previous 6 months, measured at intake, 6 months, and 1 year.
Time frame: 1 year
Cost of transportation
Total cost per mile of transportation, averaged over previous 6 months, measured at intake, 6 months, and 1 year.
Time frame: 1 year
Untreated disease(s)
Total number of attributed disease diagnoses that are not being treated, measured at intake, 6 months, and 1 year.
Time frame: 1 year
Cancer screening success
Number of eligible cancer screening exams not performed (lung, colon, breast), measured at intake, 6 months, and 1 year.
Time frame: 1 year
Unmet transportation needs
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.
Time frame: 1 year
Unmet medical transportation needs
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.
Time frame: 1 year
Prescribed medications
Total number of prescribed medications, measured at intake, 6 months, and 1 year.
Time frame: 1 year
Prescribed medications not utilized
This platform is for informational purposes only and does not constitute medical advice. Always consult a qualified healthcare professional.
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.
Time frame: 1 year
Weight
Weight in pounds, measured at intake, 6 months, and 1 year.
Time frame: 1 year
BMI
Body mass index, measured at intake, 6 months, and 1 year.
Time frame: 1 year
Blood Pressure
Blood Pressure (mmHg), measured at intake, 6 months, and 1 year.
Time frame: 1 year
Hgb A1c
Hemoglobin A1c, measured at intake, 6 months, and 1 year.
Time frame: 1 year
ADL
Activities of daily living (Barthel index), measured at intake, 6 months, and 1 year.
Time frame: 1 year
IADL
Instrumental activities of daily living (Lawton scale), measured at intake, 6 months, and 1 year.
Time frame: 1 year
Physical activity
Physical activity / exercise assessment (Modified Kaiser physical activity survey), measured at intake, 6 months, and 1 year.
Time frame: 1 year
Psychosocial assessment
Psychosocial assessment (PAT, Briggs Health), measured at intake, 6 months, and 1 year.
Time frame: 1 year
Cognitive function
Cognitive function test (CPCOG), measured at intake, 6 months, and 1 year.
Time frame: 1 year
Depression screening
Depression screening and/or assessment (MHA depression screening tool), measured at intake, 6 months, and 1 year.
Time frame: 1 year
Other mental health conditions
Other mental health conditions (MHA screening and assessment tools), measured at intake, 6 months, and 1 year.
Time frame: 1 year
Smoking assessment
Smoking / tobacco / nicotine use (No/Yes, with yes triggering LDCT assessment), measured at intake, 6 months, and 1 year.
Time frame: 1 year
Substance use
Substance use or abuse (CAGE), measured at intake, 6 months, and 1 year.
Time frame: 1 year