Surveying Physicians to Understand Health Care Disparities Affecting Persons with Disability and Identify Approaches to Improve Their Care

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According to Healthy People 2020, Americans with disability experience substantial health care disparities. A growing body of research, primarily involving individual and focus group interviews with persons with disability, has documented factors contributing to these health care disparities. Some factors reflect the personal attributes, beliefs, and preferences of individuals with disability. However, other contributors reported by persons with disability relate to systematic barriers within health care delivery systems, policies, and the attitudes and actions of physicians and other health care professionals. Nonetheless, relatively little research has examined the views, practices, and understanding of physicians about the barriers and facilitators to providing care to persons with disability, their legal responsibilities to accommodate these patients, and recommendations for improving quality of care for this population. This evidence gap raises concerns since physicians play central roles in deciding which services patients receive, initiating physical and communication accommodations, setting the tone of clinical encounters, and thus mediating health care disparities. The overall goals of this project are to understand factors that contribute to health care disparities for persons with disability from the perspective of physicians practicing in outpatient settings and to use this knowledge to make feasible recommendations for improving care. Given these overall goals, this 3-year, interdisciplinary project has 3 Specific Aims: 1. Develop the Survey of Physicians' Practices and Attitudes (SOPPA) to ask primary care and selected specialist physicians about barriers and facilitators to caring for persons with disability in outpatient settings and their recommendations to improve this care. 2. Use SOPPA to conduct and then analyze a survey of 420 practicing primary care and 420 practicing specialist physicians nationwide (total = 840 completed surveys). 3. Based on SOPPA's findings, broad literature reviews, key informant interviews, and input from persons with diverse types of disability, develop a toolkit of “best practice” strategies for reducing health care disparities and improving quality of care for persons with disability and evaluate these recommendations through additional physician and patient interviews. Improving the health and health care of individuals with disability is a critical Healthy People 2020 priority. This will be the first study to examine how physicians nationwide approach caring for persons with disability and to suggest various strategies that could be applied locally to decrease disparities and achieve equitable care for this growing population.