Implementation of Communication Disability Collection and Accommodations in Primary Care Settings

项目总结/摘要 美国残疾人法案（ADA）要求医疗保健组织和提供者确保， 残疾人可平等获得医疗保健服务、设施和方案。当助理检察官 30多年前，研究表明，残疾人继续 在健康和医疗保健方面存在巨大差距。沟通障碍者， 占美国人口的14%以上，在以患者为中心的沟通方面遇到具体挑战， 美国国家医学院的报告“跨越国界”概述了高质量护理的重要组成部分， 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 身份）和社交数据（例如，健康的社会决定因素）在电子健康记录（EHR）中的应用， 医疗保健组织、政策制定者和倡导者认为，这是推进 保健公平。不幸的是，大多数医疗机构并不一致或全面地 在电子健康记录中记录患者的残疾状况。一致和准确的残疾状况记录 需要跟踪为沟通障碍患者提供的护理质量， 需要ADA所要求的残疾住宿的患者。 该项目旨在调整和评价一揽子执行支助战略的效果， 协助初级保健诊所（1）记录病人的沟通障碍和住宿需求， EHR和（2）提供沟通障碍的住宿。在目标1中，我们将采用实施 映射适应，这将使我们能够审查现有的文献，并建立在什么是已经知道的 记录其他人口数据。通过利益相关者小组，我们将调整 执行一揽子支助，以记录通信障碍状况，并提供 初级保健环境中的通信设施。我们的最终产品将是一个多组件，多- 为在不同情况下使用而设计的一个执行级支持包。在目标2和目标3中，我们将进行 在3个医疗保健系统的9家诊所进行的多方法、混合III型有效性实施试验： 加州大学健康，丹佛健康（一个安全网健康系统），和西北医学在芝加哥，IL。主 护理诊所将是多样化的（例如，城市、农村、妇女健康和老年诊所），以最大限度地提高学习效果 在不同的背景下。我们的结果将由PRISM/RE-AIM框架指导，我们的主要 结果是达到记录病人残疾状况（目标2）和通过提供 （目标3）研究结果将为具有可扩展战略的一揽子支持提供信息 可以被改编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.