Impact of Transportation Interventions on Health Care Outcomes: A Systematic Review.

INTRODUCTION: Lack of reliable transportation can be a barrier to keeping appointments or accessing other health care services. Increasingly, insurers and health care delivery systems subsidize transportation services for patients. This systematic review synthesizes existing research on nonemergency medical transportation interventions. METHODS: We searched 3 databases (Embase, PubMed, Google) for studies of health care sector-sponsored programs that provided patients assistance with nonemergency transportation and directly assessed the impact of transportation assistance on health and health care utilization outcomes. Studies meeting inclusion criteria were graded for quality using standard grading criteria. FINDINGS: Eight studies met all inclusion criteria. Most were rated as low quality. All studies included examined process or health care utilization outcomes, such as uptake of transportation services, return for follow-up, or missed appointment rates; only 1 included health outcomes, such as illness severity and blood pressure. Results were mixed. More rigorous studies showed low patient uptake of transportation services and inconsistent impacts on health and utilization outcomes. CONCLUSIONS: Despite considerable interest in subsidizing transportation services to improve health for patients facing transportation barriers, little rigorously conducted research has demonstrated the impact of transportation services on health or health care utilization. Some extant literature suggests that transportation assistance is more likely to be effective when offered with other interventions to reduce social and economic barriers to health.

Visual feedback during motor performance is associated with increased complexity and adaptability of motor and neural output.

Complex motor behavior is believed to be dependent on sensorimotor integration - the neural process of using sensory input to plan, guide, and correct movements. Previous studies have shown that the complexity of motor output is low when sensory feedback is withheld during precision motor tasks. However, much of this research has focused on motor behavior rather than neural processing, and therefore, has not specifically assessed the role of sensorimotor neural functioning in the execution of complex motor behavior. The present study uses a stimulus-tracking task with simultaneous electroencephalography (EEG) recording to assess the effect of visual feedback on motor performance, motor complexity, and sensorimotor neural processing in healthy adults. The complexity of the EEG signal was analyzed to capture the information content in frequency bands (alpha and beta) and scalp regions (central, parietal, and occipital) that are associated with sensorimotor processing. Consistent with previous literature, motor performance and its complexity were higher when visual feedback was provided relative to when it was withheld. The complexity of the neural signal was also higher when visual feedback was provided. This was most robust at frequency bands (alpha and beta) and scalp regions (parietal and occipital) associated with sensorimotor processing. The findings show that visual feedback increases the information available to the brain when generating complex, adaptive motor output.