Patients with disabilities often require healthcare accommodations in order to access high-quality, equitable healthcare services. While attention has been paid to accommodation needs in specific disability populations, limited research to date has explored healthcare accommodations that cross-cut diverse disability populations.
To identify a deeper understanding regarding accommodations in healthcare settings that could apply across disability populations and promote equitable healthcare.
We conducted qualitative focus groups with patients with disabilities and caregivers to understand their experiences and preferences for healthcare accommodations.
We recruited patients and caregivers across all major disability categories to participate in focus groups. Participants were recruited through advocacy organizations and healthcare settings in Southeastern Minnesota.
A total of eight focus groups were conducted with 56 participants. Participants described their healthcare experiences and desires for healthcare accommodations. The multidisciplinary research team recorded, transcribed verbatim, and coded all focus groups. The team thematically coded transcripts using content analysis within and across focus groups to identify major themes.
Patients identified four challenges and corresponding steps healthcare team could take to promote equitable care: (1) consistent documentation of disabilities and needed accommodations in the medical record; (2) allowance for accommodations to the environment, including adapting physical space, physical structures, and scheduling and rooming processes; (3) provide accommodations for administrative tasks, such as completing paper or electronic forms; and (4) adapt communication during interactions, such as speaking slower or using terms that patients can easily understand.
These identified themes represent specific opportunities for healthcare teams to effectively provide accessible care to patients with disabilities. Many of the accommodations require minimal financial investment, but did require behavioral changes by the healthcare team to ensure equitable healthcare.
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Field MJ, Jette AM. The Future of Disability in America. Washington, D.C.2007.
Disability & Health Overview. 2019. (Accessed March 28th, 2020, at https://www.cdc.gov/ncbddd/disabilityandhealth/disability.html.)
Iezzoni LI. Eliminating health and health care disparities among the growing population of people with disabilities. Health Aff (Millwood) 2011;30:1947–54.
Krahn GL, Walker DK, Correa-De-Araujo R. Persons With Disabilities as an Unrecognized Health Disparity Population. Am J Public Health 2015:e1–e9.
Stransky M, Jensen K, Morris MA. Adults with Communication Disabilities Experience Poorer Health and Healthcare Outcomes Compared to People without Communication Disabilities. Journal of General Internal Medicine 2018;33:2147–55.
Winitzer RF, Bisgaier J, Grogan C, Rhodes K. “He only takes those type of patients on certain days”: specialty care access for children with special health care needs. Disabil Health J 2012;5:26–33.
Agaronnik ND, Pendo E, Campbell EG, Ressalam J, Iezzoni LI. Knowledge Of Practicing Physicians About Their Legal Obligations When Caring For Patients With Disability. Health Aff (Millwood) 2019;38:545–53.
VanPuymbrouck L, Friedman C, Feldner H. Explicit and implicit disability attitudes of healthcare providers. Rehabil Psychol 2020;65:101–12.
Lagu T, Hannon NS, Rothberg MB, et al. Access to subspecialty care for patients with mobility impairment: a survey. Ann Intern Med 2013;158:441–6.
Frost KL, Bertocci G, Stillman MD, Smalley C, Williams S. Accessibility of outpatient healthcare providers for wheelchair users: Pilot study. J Rehabil Res Dev 2015;52:653–62.
Story MF, Schwier E, Kailes JI. Perspectives of patients with disabilities on the accessibility of medical equipment: examination tables, imaging equipment, medical chairs, and weight scales. Disabil Health J 2009;2:169–79.e1.
Pharr JR. Accommodations for patients with disabilities in primary care: a mixed methods study of practice administrators. Glob J Health Sci 2014;6:23–32.
Agaronnik N, Campbell EG, Ressalam J, Iezzoni LI. Accessibility of Medical Diagnostic Equipment for Patients With Disability: Observations From Physicians. Arch Phys Med Rehabil 2019;100:2032–8.
Healthy People 2020 Disability and Health. 2020. (Accessed March 28, 2020, at https://www.healthypeople.gov/2020/topics-objectives/topic/disability-and-health/objectives.)
Iezzoni LI, Killeen MB, O'Day BL. Rural residents with disabilities confront substantial barriers to obtaining primary care. Health Serv Res 2006;41:1258–75.
Stillman MD, Bertocci G, Smalley C, Williams S, Frost KL. Healthcare utilization and associated barriers experienced by wheelchair users: A pilot study. Disabil Health J 2017;10:502–8.
Havercamp SM, Scandlin D, Roth M. Health disparities among adults with developmental disabilities, adults with other disabilities, and adults not reporting disability in North Carolina. Public health reports (Washington, DC : 1974) 2004;119:418–26.
Balogh RS, Lake JK, Lin E, Wilton A, Lunsky Y. Disparities in diabetes prevalence and preventable hospitalizations in people with intellectual and developmental disability: a population-based study. Diabet Med 2015;32:235–42.
L. K, E. L, R. C, A. H. 2017 Disability Statistics Annual Report. A Publication of the Rehabilitation Research and Training Center on Disability Statistics and Demographics. Durham, NH: University of New Hampshire; 2018.
Emerson E. Smoking among adults with and without disabilities in the UK. J Public Health (Oxf) 2018;40:e502–e9.
Parish SL, Swaine JG, Luken K, Rose RA, Dababnah S. Cervical and breast cancer-screening knowledge of women with developmental disabilities. Intellect Dev Disabil 2012;50:79–91.
Iezzoni LI, Ngo LH, Li D, Roetzheim RG, Drews RE, McCarthy EP. Early stage breast cancer treatments for younger Medicare beneficiaries with different disabilities. Health Serv Res 2008;43:1752–67.
Armour BS, Thierry JM, Wolf LA. State-level differences in breast and cervical cancer screening by disability status: United States, 2008. Womens Health Issues 2009;19:406–14.
Ramjan L, Cotton A, Algoso M, Peters K. Barriers to breast and cervical cancer screening for women with physical disability: A review. Women Health 2016;56:141–56.
Americans with Disabilities Act of 1990, As Amended. 2009. (Accessed May 1st, 2013, at http://www.ada.gov/pubs/adastatute08.htm.)
Patient Protection and Affordable Care Act. In: Senate and House of Representatives of the United States of America, ed. PL 111-148 2010.
Nondiscrimination in Health Programs and Activities. Final rule. Federal register 2016;81:31375–473.
Mudrick NR, Breslin ML, Liang M, Yee S. Physical accessibility in primary health care settings: results from California on-site reviews. Disabil Health J 2012;5:159–67.
Story MF, Kailes JI, Donald CM. The ADA in action at health care facilities. Disabil Health J 2010;3:245–52.
Morris MA, Maragh-Bass AC, Griffin JM, Finney Rutten LJ, Lagu T, Phelan S. Use of Accessible Examination Tables in the Primary Care Setting: A Survey of Physical Evaluations and Patient Attitudes. J Gen Intern Med 2017;32:1342–8.
Past CMS health equity award winners. 2020. at https://www.cms.gov/About-CMS/Agency-Information/OMH/equity-initiatives/Past-Health-Equity-Award-Winners.)
Accessible medical & dental care providers. 2020. at https://www.theindependencecenter.org/get-involved/advocacy/accessible-medical-equipment/.)
Mudrick NR, Swager LC, Breslin ML. Presence of Accessible Equipment and Interior Elements in Primary Care Offices. Health Equity 2019;3:275–9.
Morris MA, Lagu T, Maragh-Bass A, Liesinger J, Griffin JM. Development of Patient-Centered Disability Status Questions to Address Equity in Care. Joint Commission journal on quality and patient safety 2017;43:642–50.
Hsieh HF, Shannon SE. Three approaches to qualitative content analysis. Qual Health Res 2005;15:1277–88.
Iezzoni LI, Kilbridge K, Park ER. Physical access barriers to care for diagnosis and treatment of breast cancer among women with mobility impairments. Oncol Nurs Forum 2010;37:711–7.
Iezzoni LI, Wint AJ, Smeltzer SC, Ecker JL. Physical Accessibility of Routine Prenatal Care for Women with Mobility Disability. Journal of women's health (2002) 2015;24:1006–12.
Morrison EH, George V, Mosqueda L. Primary care for adults with physical disabilities: perceptions from consumer and provider focus groups. Family medicine 2008;40:645–51.
Iezzoni LI, O'Day BL, Killeen M, Harker H. Communicating about health care: observations from persons who are deaf or hard of hearing. Ann Intern Med 2004;140:356–62.
Nicolaidis C, Raymaker DM, Ashkenazy E, et al. “Respect the way I need to communicate with you”: Healthcare experiences of adults on the autism spectrum. Autism 2015;19:824–31.
Morris MA, Dudgeon BJ, Yorkston K. A qualitative study of adult AAC users' experiences communicating with medical providers. Disabil Rehabil Assist Technol 2013;8:472–81.
Morris MA, Clayman ML, Peters KJ, Leppin AL, LeBlanc A. Patient-centered communication strategies for patients with aphasia: Discrepancies between what patients want and what physicians do. Disabil Health J 2015;8:208–15.
Sheppard K. Deaf adults and health care: Giving voice to their stories. J Am Assoc Nurse Pract 2014;26:504–10.
Horner-Johnson W, Dobbertin K, Lee JC, Andresen EM. Disparities in health care access and receipt of preventive services by disability type: analysis of the medical expenditure panel survey. Health Serv Res 2014;49:1980–99.
Pharr J. Accessible medical equipment for patients with disabilities in primary care clinics: why is it lacking? Disabil Health J 2013;6:124–32.
Morris MA, Hasnain-Wynia R. A Research Agenda for Documenting Disability Status within Healthcare Organizations to Address Disparities in Care. J Healthc Qual 2014;36:7–13.
The study was funded by the National Institute on Disability, Independent Living and Rehabilitation Research, and the Mayo Clinic’s Robert D. and Patricia E. Kern Center for the Science of Healthcare Delivery.
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Morris, M.A., Wong, A.A., Dorsey Holliman, B. et al. Perspectives of Patients with Diverse Disabilities Regarding Healthcare Accommodations to Promote Healthcare Equity: a Qualitative Study. J GEN INTERN MED (2021). https://doi.org/10.1007/s11606-020-06582-8
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