Data Element

Transportation Insecurity
Description

A condition in which one is unable to regularly move from place to place in a safe and timely manner because one lacks the material, economic or social resources necessary for transportation. (Alix Gould-Werth, Jamie Griffin & Alexandra K. Murphy, “Developing a New Measure of Transportation Insecurity: An Exploratory Factor Analysis,” 11(2) Survey Practice , p. 1 (2018).) Currently under consideration by and in process with the Gravity community.

Comment

CMS-CCSQ Recommend advancing Transportation Insecurity to Level2

Data Element: Transportation Insecurity (Level 0)

  1. Recommendation: Advance the Transportation Insecurity data element to Level 2.
  2. Rationale: CMS recommends advancing the data element Transportation Insecurity to Level 2, as it is currently captured and exchanged in various PAC assessment tools, including the IRF-PAI, LCDS, MDS 3.0, and OASIS, with LOINC codes 93030-5 (OASIS) and 101351-5 (IRF-PAI, LCDS, MDS 3.0). The question associated with this data element is, “Has lack of transportation kept you from medical appointments, meetings, work, or from getting things needed for daily living?” The Transportation item was derived from the national PRAPARE® social drivers of health assessment tool (2016), which was developed and is owned by the National Association of Community Health Centers (NACHC). Promoting Transportation Insecurity to Level 2 will enhance standardization during transitions of care and supports interoperability across healthcare systems thereby assisting healthcare providers to  better understand their patients' social support systems and provide targeted interventions to improve their transportation needs and promote better health outcomes  Furthermore, this inclusion aligns with the White House's US Playbook to Address the Social Determinants of Health, underscoring its critical role in promoting health equity and addressing the social factors that influence overall health.

Reaffirming support for SDOH data elements

The National Association of Community Health Centers (NACHC) remains steadfast in its commitment to advocating for and prioritizing Social Determinants of Health (SDOH) data elements. Recognizing the critical role that these factors play in shaping the clinical outcomes of community health center patients, NACHC continues to emphasize the need for comprehensive, accurate, and interoperable SDOH data. By reaffirming our support for these essential elements, we aim to drive informed decision-making, policy development, and targeted interventions that address the root causes of health disparities. This underscores NACHC's belief in the transformative potential of SDOH data in building healthier, more equitable communities.

2023-09-20 NACHC USCDIv5 Letter of Support_2.pdf

Transportation Insecurity is a key SDOH data element

NACHC support for the inclusion of "Transportation Insecurity" as a required data element for interoperability across electronic health records systems for USCDI. Healthcare providers in community health centers have seen firsthand the significant impact that transportation insecurity can have on a patient's health outcomes.

An example of a code that represents transportation insecurity is the ICD-10-CM code Z59.82.

By standardizing the collection and sharing of information on transportation insecurity across electronic health records systems, healthcare providers can better identify patients who may face transportation barriers to accessing healthcare. This information can help providers tailor their care to the unique needs of their patients, such as by providing information on transportation resources or scheduling appointments at more accessible locations.

Furthermore, incorporating transportation insecurity as a required data element can help to address healthcare disparities and improve health equity. Patients who lack adequate transportation may face barriers in accessing preventive care, chronic disease management, and other essential healthcare services. By capturing this information and ensuring its interoperability, healthcare providers can work to mitigate the impact of transportation insecurity on patient outcomes.

Transportation Insecurity as SDOH data element under USCDI or IS

NACHC would like to resupport this data element for consideration / inclusion to USCDIv3.

All federally qualified health centers (FQHCs) gather SDOH data, which includes a focus on this data element through the PRAPARE screening tool. This data is relevant to and encompasses in 2019 29 million patients at 1400+ FQHCs with more than 13000 health care delivery sites. 

If this data element is not considered for addition to USCDI, we would like to comment on it's addition to ISA as a coded data element under SDOH, with applicable standards and representation accross ICD-10-CM, SNOMED-CT and LOINC.

Please see attached document supporting this. 

2022-09-30 NACHC USCDIv3 Letter of Support_15.pdf

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