1 of 13

ROAM�January 07, 2024

Katherine Freund

ITNAmerica, CEO��

www.ITNAmerica.org

Transportation and the Social Determinants of Health for Older Adults:

A Data Analysis & Longitudinal Research Plan

2 of 13

Transportation & the Social Determinants of Health�for Older Adults: A Data Analysis & Longitudinal Research Plan

Project Goals

Goal 1: Conduct the first detailed statistical analysis of ITNAmerica’s legacy research database

Goal 2: Develop a research design for a cost-effective longitudinal study of the relationship between transportation and access to healthcare

www.ITNAmerica.org

3 of 13

www.ITNAmerica.org

Our Mission

ITNAmerica promotes lifelong mobility for older adults and people with mobility challenges. We support sustainable, community-based transportation by leading a national transportation network grounded in technology, research, policy analysis and education.

ITNAmerica is the first national, non-profit transportation network.

4 of 13

Four Pillars: Digital Support Community Mobility

ITNRides 2.0 – ITNAmerica’s enterprise ride coordination software on Salesforce

Rides in Sight – Largest national free searchable online database of transportation options�
America’s Volunteer Driver Center – National public information campaign to change the way Americans think about and support community mobility�
Community in the Cloud – Online learning and support system.

www.ITNAmerica.org

5 of 13

ITNRides 2.0 – 1.5 million rides

ITNAmerica’s enterprise software includes a 178-field research database to support community transportation programs across the country�
World-class technology on the Salesforce platform with routing algorithms donated by Esri, made affordable to nonprofit transportation providers in communities of all sizes

www.ITNAmerica.org

6 of 13

Rides by Purpose: 1997-2021

www.ITNAmerica.org

7 of 13

Data-driven reports drive better health:�282,322 Medical Rides �Total Rides (1995 - 2/25/21) = 1.3 Million

www.ITNAmerica.org

8 of 13

Goal 1: Statistical Analysis

Objective A: Migrate Data

26 legacy databases

June 1996 data collection began on ITNRides 1.5

May 2021 ITNRides 2.0 transition to Salesforce, a single multi-tenant database

All data collected at ITN sites across the country are entered into this database, supporting future point-in-time or longitudinal analyses

Data are structured differently in ITNRides 2.0 and ITNRides 1.5, so data object relationships must be “re-shaped” while maintaining the integrity of the legacy data.

www.ITNAmerica.org

9 of 13

Goal 1: Statistical Analysis

Objective B: Plan Statistical Analysis

Conduct exploratory analysis on rides from 1996 to 2023

Generate univariate descriptive statistics and graphics to understand the distributional characteristics of the variables.

Generate means, standard deviations, and quantiles for continuous measures. Enhance the analysis for each variable with box plots, histograms, and quantile-quantile plots.

Investigate extreme values to verify validity. Produce counts, proportions and bar charts for categorical variables.

The Scientific Advisory Panel (SAP) will review results before estimating and testing associations of interest.

www.ITNAmerica.org

10 of 13

Goal 1: Statistical Analysis

Objective C: Perform Statistical Analysis

The data should reveal trends over time in utilization and related factors.

Examine relationships between sets of pairs of variables focusing on such social determinants of health as nutrition, socialization and transportation access to healthcare.

These bivariate analyses will inform the development of statistical models that integrate all relevant independent variables to assess the independent associations of these variables with outcomes of interest.

Models may be used to examine potential complex relationships from the intersectional effects of factors.

Consult SAP regarding analytic results.

www.ITNAmerica.org

11 of 13

Goal 2: Design Longitudinal Study

Objective A: Longitudinal Design

Determine variables to examine in the longitudinal study (with SAP input).

Determine if any additional data collection fields should be added to ITNRides 2.0.

Decide survey instruments to develop and validate questions with the SAP.

Recruit representatives from medical specialties to develop interviews and surveys to identify salient issues for riders and healthcare providers.

Recruit representatives of under-served populations, such as uninsured, low-income, LGBTQ, Native American, and African American for a Stakeholder Advisory Panel to inform drafting and review of interview and survey instruments.

With advice from both the Scientific and Stakeholder Advisory Panels, along with advice from medical specialties, develop a comprehensive timeline and work plan for a multi-year longitudinal study.

www.ITNAmerica.org

While detailed statistical analysis of the ITNRides data set will provide significant insight into populations as a whole, it is the focus on individuals over time that will offer qualitative insight into person-centered transportation behavior. A longitudinal study will provide a comprehensive research approach that offers insight into individual behavior and change over time and produce qualitative data based on behavior analysis. The ITNRides 2.0 database is an ideal subject for study because many riders stay with the transportation service for the rest of their lives, and because operational software programmed to automatically collect 178 fields of data is extremely costeffective. Every rider signs an informed consent when they enter the service, but an additional informed consent is necessary for participation in the longitudinal study.

12 of 13

Goal 2: Design Longitudinal Study

Objective B: Implement Change Strategy

To put insights from findings into a real world change strategy, ITNAmerica will integrate knowledge gained into community transportation support programs, board development, ITNRides, and AVDC’s policy and practice.

ITNAmerica will build an online learning module on mobility and healthcare with a focus on oral healthcare.

ITNAmerica will disseminate knowledge through FQHCs, community health workers, and such organizations as National Network of Public Health Institutes, and social and earned media.

ITNAmerica will present findings at an annual conference of a national organization such as the American Public Health Association, the American Society on Aging or the Transportation Research Board.

www.ITNAmerica.org

While detailed statistical analysis of the ITNRides data set will provide significant insight into populations as a whole, it is the focus on individuals over time that will offer qualitative insight into person-centered transportation behavior. A longitudinal study will provide a comprehensive research approach that offers insight into individual behavior and change over time and produce qualitative data based on behavior analysis. The ITNRides 2.0 database is an ideal subject for study because many riders stay with the transportation service for the rest of their lives, and because operational software programmed to automatically collect 178 fields of data is extremely costeffective. Every rider signs an informed consent when they enter the service, but an additional informed consent is necessary for participation in the longitudinal study.

13 of 13

Contact Information

www.ITNAmerica.org

Katherine Freund

President & CEO, ITNAmerica

207.415.1630

Katherine.Freund@ITNAmerica.org