Implementation of Communication Disability Collection and Accommodations in Primary Care Settings

在初级保健机构中实施沟通障碍收集和住宿

• 批准号: 10705832
• 负责人: Megan A Morris
• 金额: $ 76.69万
• 依托单位: UNIVERSITY OF COLORADO DENVER
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-09-16 至 2027-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10705832
• 关键词: Academy; Address; Adoption; Adult; Adverse event; Advocate; Affect; Americans with Disabilities Act; Appointment; Arthritis; Asthma; Caring; Characteristics; Chicago; Chronic; Clinic; Clinical; Collection; Colorado; Communication; Communication Board; Communication Disability; Communities; Data; Diabetes Mellitus; Disabled Persons; Disparity; Documentation; Educational Intervention; Elderly; Electronic Health Record; Ensure; Equitable healthcare; Equity; Ethnic Origin; Event; Gender Identity; Goals; Health; Health system; Healthcare; Healthcare Systems; Hearing; Hearing Aids; Hospitalization; Hybrids; Hypertension; Individual; Infant Mortality; Inpatients; Intake; Intervention; Justice; Language; Language Disorders; Learning; Literature; Maps; Maternal Mortality; Medical; Medical History; Medicine; Methods; Outcome; Patient Care; Patients; Persons; Policy Maker; Population; Practical Robust Implementation and Sustainability Model; Process; Provider; Quality of Care; Race; Reach, Effectiveness, Adoption, Implementation, and Maintenance; Reporting; Research; Rural; Sex Orientation; Social support; Source; Speech; Testing; United States; Visit; Voice; Woman; Women' s Health; Work; care outcomes; demographics; design; disability; effectiveness/implementation trial; evidence base; experience; federal policy; health care availability; health care disparity; health care service; health care service organization; health care settings; health data; health disparity; health equity promotion; health information technology; implementation evaluation; implementation outcomes; implementation strategy; marginalized population; patient oriented; patient portal; primary care clinic; primary care practice; primary care setting; primary outcome; programs; safety net; social; social health determinants; willingness; Academy; Address; Adoption; Adult; Adverse event; Advocate; Affect; Americans with Disabilities Act; Appointment; Arthritis; Asthma; Caring; Characteristics; Chicago; Chronic; Clinic; Clinical; Collection; Colorado; Communication; Communication Board; Communication Disability; Communities; Data; Diabetes Mellitus; Disabled Persons; Disparity; Documentation; Educational Intervention; Elderly; Electronic Health Record; Ensure; Equitable healthcare; Equity; Ethnic Origin; Event; Gender Identity; Goals; Health; Health system; Healthcare; Healthcare Systems; Hearing; Hearing Aids; Hospitalization; Hybrids; Hypertension; Individual; Infant Mortality; Inpatients; Intake; Intervention; Justice; Language; Language Disorders; Learning; Literature; Maps; Maternal Mortality; Medical; Medical History; Medicine; Methods; Outcome; Patient Care; Patients; Persons; Policy Maker; Population; Practical Robust Implementation and Sustainability Model; Process; Provider; Quality of Care; Race; Reach, Effectiveness, Adoption, Implementation, and Maintenance; Reporting; Research; Rural; Sex Orientation; Social support; Source; Speech; Testing; United States; Visit; Voice; Woman; Women' s Health; Work; care outcomes; demographics; design; disability; effectiveness/implementation trial; evidence base; experience; federal policy; health care availability; health care disparity; health care service; health care service organization; health care settings; health data; health disparity; health equity promotion; health information technology; implementation evaluation; implementation outcomes; implementation strategy; marginalized population; patient oriented; patient portal; primary care clinic; primary care practice; primary care setting; primary outcome; programs; safety net; social; social health determinants; willingness

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.

项目摘要/摘要 《美国残疾法案》（ADA）要求医疗组织和提供者确保 残疾患者可以平等地获得医疗服务，设施和计划。而ADA 研究已于30年前通过，研究表明，残疾人继续 经历重大的健康和医疗保健差异。沟通残障人士，谁 代表美国人口的14％，面临以患者为中心的沟通的具体挑战，这是 美国国家医学院概述的高质量护理的基本组成部分报告“越过 优质的鸿沟”。 患者人口统计信息的文档（例如种族/种族，性取向和性别 身份）和电子健康记录（EHR）中的社会数据（例如，健康的社会决定因素） 医疗组织，政策制定者和倡导者的认可是前进的必要步骤 医疗保健权益。不幸的是，大多数医疗保健组织并非一致或全面 记录患者在EHR内的残疾状况。一致，准确的残疾状态记录 需要跟踪交付给沟通障碍患者的护理质量并确定 需要ADA需要残疾住宿的患者。 该项目旨在调整和评估实施策略的实施支持包的影响 在（1）文档患者的沟通障碍和适应需求中协助初级保健诊所 EHR和（2）提供沟通残疾的住宿。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文献并基于已经知道的知识 实施其他人口统计数据的文档。使用利益相关者小组，我们将适应 实施支持包，用于通讯残疾状态的记录和提供 初级保健环境中的沟通住宿。我们的最终产品将是多组分的多组分 级别实现支持软件包，旨在在不同上下文中使用。在AIM 2和3中，我们将进行 在3个医疗保健系统中的9个诊所中的多方法，III型混合有效性实施试验： 伊利诺伊州芝加哥的Uchealth，丹佛健康（安全网卫生系统）和西北医学。主要 护理诊所将是潜水员（例如，城市，粗糙，妇女健康和老年诊所），以最大化学习 在不同的上下文中。我们的结果将由Prism/Re-Aim框架进行指导 结果是记录患者残疾状况的文档（目标2）和采用条款 残疾住宿（AIM 3）研究结果将为支持包提供可扩展策略的支持包 可以将其适应并推广到其他类型的疾病。