The goal of this pilot randomized controlled trial is to assess the impact of D2D rideshare services with a trained companion driver on the rate of medical appointments for older adults and individuals with AD/ADRD. Participants will be assigned either door-through-door (D2D) rideshare or curb-to-curb (C2C) rideshare services. he main question it aims to answer is: Do D2D rideshare services reduce missed medical appointment rates compared to C2C rideshare services?
A pilot randomized controlled trial (Stage 1). By stratifying on levels of cognitive impairment, i.e., no cognitive impairment vs. have mild to moderate cognitive impairment/MCI or subjective cognitive decline/SCD, the research team will randomly assign 120 riders, who have scheduled medical appointments at partner practices of Onward, to one of two groups: Onward D2D service (intervention) vs. C2C rideshare (control). Intervention Group (D2D): Door-to-Door rideshare services with a trained companion driver. Control Group (C2C): Standard Curb-to-Curb rideshare services.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
SUPPORTIVE_CARE
Masking
NONE
Enrollment
120
Door-through-Door Companion Drivers, unlike traditional rideshare services, are certified in CPR and first aid, and undergo onboard training to support older adults, individuals with mobility impairments, and those with AD/ADRD. They are trained to observe behaviors of AD/ADRD patients, monitor and detect risk of falls, elopement, and other events that may require extra assistance or emergency care during transport. Drivers accompany riders continuously until they can hand off riders to clinicians or other caregivers, or return them to their home. Technology features in the rideshare platform enable continuity of care, for consistent rider-driver matching and matching of riders to drivers based on support needs.
Curb to curb rideshare services provided by a transportation network company (TNC) with drivers who don't have specialized training in supporting healthcare riders and who don't undergo fingerprint background checks or drug and alcohol testing.
Onward Health HQ
San Leandro, California, United States
RECRUITINGAppointment Adherence
The rate of missed medical appointments (No shows and same day cancellations).
Time frame: 9 Months
Quality of Life (QOL)
The impact of the intervention on participants' quality of life (QOL), as measured every 3 months during the study period using the ICECAP-A (ICEpop CAPability measure for Adults) Wellbeing and Quality of Life scale. ICECAP-A has the following five attributes, each of which can take one of four levels ranging from full capability to no capability, higher scores are better outcomes: * Stability (being able to feel settled and secure) * Attachment (being able to have love, friendship and support) * Autonomy (being able to be independent) * Achievement (being able to achieve and progress) * Enjoyment (being able to have enjoyment and pleasure)
Time frame: 9 months
Ride Acceptance Rates
Participant acceptance of the ride offered.
Time frame: 9 Months
Ride Completion Rates
The completion rate of rides scheduled, as measured by the number of ride "No Shows" relative to rides booked.
Time frame: 9 Months
Ride Satisfaction
Rider satisfaction with the rides received as rated on a 5 point star scale with 1 star being the lowest rating and 5 stars being the highest.
Time frame: 9 Months
Transportation as a SDoH
Self reported unmet transportation needs as measured via surveys conducted every 3 months during the study period using Protocol for Responding to \& Assessing Patients' Assets, Risks \& Experiences (PRAPARE®) SDoH questionnaire transportation questions below. In the past 12 months, has lack of reliable transportation kept you from medical appointments, meetings, work or from getting things needed for daily living? Yes No Do you have trouble finding or paying for transportation? Yes No Has the inability to get your medications or get to appointments for care ever resulted in an emergency room visit or required hospitalization? Yes No
Time frame: 9 Months
Caregiver Burnout
Participant caregiver ratings of caregiver burnout as measured by a survey conducted every 3 months during the study period using the HealthinAging.org Caregiver Self Assessment. Source: HealthinAging.org - https://www.healthinaging.org/tools-and-tips/caregiver-self-assessment-questionnaire The assessment asks 18 questions, 16 are Yes/No with scores over 10 "Yes" indicating burnout, and 2 on a 1-10 scale with scores over 6 indicating burnout.
Time frame: 9 Months
Rider Loneliness and Social Isolation
Loneliness and Social Isolation will be measured every 3 months using the UCLA 3-Item Loneliness Scale. 1. First, how often do you feel that you lack companionship: Hardly ever (1), some of the time (2), or often (3)? 2. How often do you feel left out: Hardly ever (1), some of the time (2), or often (3)? 3. How often do you feel isolated from others: Hardly ever (1), some of the time (2), or often (3)? Scoring: Sum the total of all items. Higher scores indicate greater degrees of loneliness. Possible range of scores from 3 to 9. Researchers in the past have grouped people who score 3 - 5 as "not lonely" and people with the score 6 - 9 as "lonely".
Time frame: 9 Months
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