Evaluation of Uber Health Program at the UAB Sickle Cell Center

Abstract Background Sickle cell disease (SCD) is a chronic condition that requires frequent clinical and infusion visits to manage pain and prevent organ damage. Transportation barriers represent a major problem that limits healthcare access, especially for people with frequent appointments or who have driving limitations. Distance from a treatment center is the most recognized transportation obstacle, however even people who live close to a SCD center may have barriers including automobile reliability, affordability, ability to drive, ownership of a driver’s license and insurance. According to the Center for Medicare & Medicaid Services, transportation issues account for >/=25% of missed non-emergent clinic appointments. Following the implementation of the Comprehensive SCD Program at UAB in 2019, the patient population more than doubled, intensifying the need for reliable transit solutions. To address this, the LifeSpan Comprehensive Sickle Cell Center (LCSCC) implemented the Uber Health program in April 2020 to provide transportation for people with SCD. This study evaluates the use of the program including geographic reach, number of persons served and cost trends over a two-year period. Methods This is a retrospective analysis of completed Uber rides for clinic and infusion appointments for adults with SCD followed by the UAB LCSCC. Uber Health data was evaluated from January 2023 through December 2024. At UAB, the use of Uber Health must be initiated by the hospital program (not at will by the patient). Our program provided Uber health for clinic appointments, infusion and pharmacy visits . Rides are limited to ≤ 2 rides/month per person and patients were limited to a reliable uber range (usually within 60-mile radius). Statistical analysis included descriptive metrics, demographics, total number of rides, average rides per patient, and total program costs. Results Over the two-year period, the UAB LCSCC treated approximately 800 adults. Uber rides were offered to all persons within the designated range and were accepted by 148 (18.5%) of the clinic population. The goal was to improve access to routine SCD appointments, transfusions, acute pain management, and primary care visits. The majority were female (n = 89, 60.1%). The majority were aged 30-49 years (n = 61, 41.7%), followed by those < 30 years (n = 58, 39.7%), and those >50 years (n = 27, 18.5%). Most people had HbSS disease (n = 93, 63.6%), followed by HbSC (n = 35, 24%), and other SCD genotypes (n = 16, 11) which mirrors the overall population at our center. Program use increased from 105 to 116 persons and rides from 1,250 (11.9 per person) to 1,547 (13.3 per person) between 2023 and 2024. The median distance to clinic travelled was 9.9 miles in 2023 and 9.1 miles in 2024 (Maximum distance 99.38 miles in 2023 to 151 miles in 2024). Figure 1 illustrates the catchment area of persons who used the program. Total costs rose 25.9% ($40,173 to $50,587), while average cost/ride remained stable ($32.14 to $32.70). Average cost/person increased 14% ($382.60 to $436.10). There were no identified safety issues or concerns raised by patients using this service. The majority of patients who used the service requested repeated rides over the years studied. Conclusions Transportation barriers are a common reason for missed appointments in the SCD clinic. Further, when patients need treatment for acute pain (with opioids), each patient requires a driver which is not always available to them. However, Uber Health is a safe way of transporting persons after they have received pain management without concern for automobile-related injuries. The Uber Health program provides one method of overcoming transportation hurdles at the UAB Sickle Cell Center. Unfortunately, the program is limited both financially and due to distance. More than 50% of the UAB SCD population lives outside of the 60-mile radius and could not use this transportation option. Despite these limitations, these data support the feasibility of using ride share services as one potential solution to overcome transportation limitations. The program’s growth over the two-year period demonstrates patient engagement. Future studies should evaluate the impact of Uber Health on clinical outcomes including acute care use and long-term cost-effectiveness.