Implementation of Communication Disability Collection and Accommodations in Primary Care Settings

项目摘要/摘要 《美国残疾人法案》(ADA)要求医疗保健组织和提供者确保 残疾患者可以平等地获得医疗服务、设施和方案。虽然美国反兴奋剂机构 是在30多年前通过的，研究表明残疾人继续 体验显著的健康和医疗保健差异。有沟通障碍的人， 代表着14%的美国人口，经历了以患者为中心的沟通的具体挑战，以及 高质量护理的基本组成部分，如美国国家医学研究院报告《跨越 质量鸿沟“。 记录患者的人口统计信息(例如，种族/民族、性取向和性别 电子健康记录(EHR)中的身份)和社会数据(例如，健康的社会决定因素) 医疗保健组织、政策制定者和倡导者认为这是推进 医疗保健股权。不幸的是，大多数医疗机构没有始终如一地或全面地 在电子病历中记录患者的残疾状况。一致和准确的残疾状况记录 需要跟踪向有沟通障碍的患者提供的护理质量并确定 需要美国残疾人协会要求的残疾住宿的患者。 该项目旨在调整和评估执行一揽子战略支助的效果，以 协助初级保健诊所(1)记录患者的沟通障碍和住宿需求 电子病历和(2)提供沟通障碍设施。在目标1中，我们将采用实施 地图调整，这将使我们能够回顾现有的文献并在已知的基础上进行改进 实施其他人口统计数据的文件编制。通过利益相关者小组，我们将调整 用于记录通信残疾状况的执行支助包和提供 初级保健环境中的沟通便利。我们的最终产品将是一个多组件，多- 为在不同环境中使用而设计的级别实施支持包。在目标2和目标3中，我们将进行 多方法、混合型III有效性--在3个医疗保健系统的9个诊所进行实施试验： 加州大学健康分校、丹佛健康(一个安全网医疗系统)和伊利诺伊州芝加哥的西北医学。初级阶段 护理诊所将是多样化的(例如，城市、农村、妇女保健和老年诊所)，以最大限度地提高学习能力 跨越不同的环境。我们的成果将以PRISM/RE-AIM框架为指导，我们的主要 结果是记录患者残疾状况的范围(目标2)和采用规定 残疾人士住宿(目标3)研究结果将为支持方案提供可扩展的战略 这可以适应和推广到其他类型的残疾。

PROJECT SUMMARY/ABSTRACT The Americans with Disability Act (ADA) requires that healthcare organizations and providers ensure that patients with disabilities receive equal access to healthcare services, facilities and programs. While the ADA was passed more than 30 years ago, research demonstrates that persons with disabilities continue to experience significant health and healthcare disparities. Persons with communication disabilities, who represent >14% of the US population, experience specific challenges to patient-centered communication, an essential component of high-quality care as outlined by the National Academy of Medicine report “Crossing the Quality Chasm”. Documentation of patients’ demographic information (e.g., race/ethnicity, sexual orientation, and gender identity) and social data (e.g., Social Determinants of Health) in electronic health records (EHR) has been recognized by healthcare organizations, policy makers and advocates as a necessary step towards advancing healthcare equity. Unfortunately, most healthcare organizations do not consistently or comprehensively document patients’ disability status within the EHR. Consistent and accurate documentation of disability status is needed to track the quality of care delivered to patients with communication disabilities and to identify patients who need disability accommodations required by the ADA. This project aims to adapt and evaluate the effects of an implementation support package of strategies to assist primary care clinics in (1) documenting patients’ communication disability and accommodation needs in the EHR and (2) providing communication disability accommodations. In Aim 1 we will employ Implementation Mapping Adapt, which will allow us to review existing literature and build upon what is already known about implementation of documentation of other demographic data. With a stakeholder panel, we will adapt an implementation support package for documentation of communication disability status and provision of communication accommodations in the primary care setting. Our final product will be a multi-component, multi- level implementation support package designed for use in varying contexts. In Aim 2 and 3, we will conduct a multi-method, Hybrid Type III effectiveness-implementation trial across 9 clinics in 3 healthcare systems: UCHealth, Denver Health (a safety net health system), and Northwestern Medicine in Chicago, IL. The primary care clinics will be diverse (e.g., urban, rural, women’s health, and geriatric clinics) to maximize learnings across different contexts. Our outcomes will be guided by the PRISM/RE-AIM framework, with our primary outcomes being the Reach of documentation of patients’ disability status (Aim 2) and the Adoption of provision of disability accommodations (Aim 3.) The study findings will inform a support package with scalable strategies that can be adapted and generalized to other types of disabilities.