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

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.

项目概要/摘要 《美国残疾人法案》(ADA) 要求医疗保健组织和提供者确保： 残疾人可以平等地获得医疗服务、设施和项目。 该法案已于 30 多年前通过，研究表明残疾人继续 有沟通障碍的人在健康和医疗保健方面存在显着差异。 >14% 的美国人口在以患者为中心的沟通方面遇到了特定的挑战， 正如美国国家医学院报告“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） 被医疗保健组织、政策制定者和倡导者认为是推进的必要步骤 不幸的是，大多数医疗保健组织并没有一致或全面地实现医疗保健公平。 在 EHR 中记录患者的残疾状况 一致且准确的残疾状况记录。 需要跟踪为有沟通障碍的患者提供的护理质量并确定 需要 ADA 要求的残障人士便利设施的患者。 该项目旨在调整和评估战略实施支持包的效果，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 (EHR) 以及 (2) 为沟通障碍者提供便利 在目标 1 中，我们将采用实施措施。 Mapping Adapt，这将使我们能够回顾现有文献并在已知的基础上进行构建 通过利益相关者小组，我们将调整其他人口统计数据的记录。 实施支持包，记录沟通障碍状况并提供 我们的最终产品将是一个多组件、多用途的解决方案。 设计用于不同环境的级别实施支持包 在目标 2 和 3 中，我们将进行一次实施。 在 3 个医疗保健系统的 9 家诊所进行多方法、混合 III 型有效性实施试验： UCHealth、丹佛健康中心（安全网健康系统）和伊利诺伊州芝加哥的西北医学中心。 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 我们的成果将以 PRISM/RE-AIM 框架为指导，我们的主要目标是 结果是患者残疾状况记录的范围（目标 2）和规定的采用 残疾人便利设施（目标 3。）研究结果将为具有可扩展策略的支持包提供信息 可以对其进行调整并推广到其他类型的残疾。