People with disabilities report physical barriers in doctors’ offices that affect the quality of care.  The analysis seeks to describe overall primary care office physical accessibility and identify (1) in which areas offices meet access criteria, (2) which accessibility criteria are most often not met, and (3) whether there are urban/non-urban differences

Breslin, Mary Lou

Liang, Mengke

Mudrick, Nancy R.

Yee, Silvia

English

Syracuse University Research Facility and Collaborative Environment

Syracuse University SURFACE School of Social Work David B. Falk College of Sport and Human Dynamics December 2010 Accessibility of Primary Health Care Settings for People with Disabilities Nancy R. Mudrick Syracuse University Mary Lou Breslin Disability Rights Education and Defense Fund Mengke Liang Syracuse University Silvia Yee Disability Rights Education & Defense Fund Follow this and additional works at: https://surface.syr.edu/swk  Part of the Health Services Research Commons, Public Affairs, Public Policy and Public Administration Commons, and the Social Work Commons Recommended Citation Mudrick, Nancy R.; Breslin, Mary Lou; Liang, Mengke; and Yee, Silvia, "Accessibility of Primary Health Care Settings for People with Disabilities" (2010). School of Social Work. 2. https://surface.syr.edu/swk/2 This Presentation is brought to you for free and open access by the David B. Falk College of Sport and Human Dynamics at SURFACE. It has been accepted for inclusion in School of Social Work by an authorized administrator of SURFACE. For more information, please contact surface@syr.edu. Accessibility of Primary Health Care Settings for People with DisabilitiesN.R. Mudrick‡, Ph.D.; M. Liang‡, MSW;M.L. Breslin*, M.A.; S. Yee*, J.D.December, 2010‡Syracuse University *Disability Rights Education & Defense FundThis research was supported by a grant from the California Health Care Foundation.We thank the five California health plans that provided us with data and Brenda Premo,  Harris Family Center for Disability & Health Policy, Western University of Health Sciences, Pomona, CA., for linking us to the plans.Contact: Nancy R. Mudrick, mudrick@syr.eduMary Lou Breslin,   mlbreslin@dredf.orgMudrick, et. al. (2010). Accessibility of Primary  Health Care Settings for People with DisabilitiesBackground:  Data from PatientsQualitative studies describe patient experiences of barriers with doctors and health care settings– Physical barriers to care, inaccessibility of equipment– Attitudes and stereotypes held by medical providers– Lack of appropriate training or knowledge– Programmatic and procedural barriersADA settlements by the U.S. Department of Justice document access problems and violations– Failures of effective communication (62.4%)– Inaccessible exterior, includes parking (10.2%)– Inaccessible interior - exam rooms, restrooms (6.5%)Mudrick, et. al. (2010). Accessibility of Primary  Health Care Settings for People with DisabilitiesBackground:  Data from Healthcare ProvidersIt has been difficult to obtain data from providers; thus it has been difficult to obtain a quantitative estimate of access barriers.Self-administered surveys of providersGrabois, Nosek, & Rossi (1999): n=62McNeal, Carothers, & Premo (2002): n=501Iezzoni & O’Day (2006): n ≈20California Foundation for Independent LivingCenters & Cohen (2006): n=10  (health plans)On-site rating of provider by outside reviewer Sanchez, et. al. (2000): n=40Graham & Mann (2008): n=68Mudrick, et. al. (2010). Accessibility of Primary  Health Care Settings for People with DisabilitiesResearch QuestionsWhat is the extent of primary care office physical accessibility to patients with disabilities?• In which areas are most offices fully accessible?• What are the areas in which accessibility is most deficient?• Are there variations by primary care specialty?• Are there differences urban/non-urban?What are the policy implications and applications of this access assessment?Mudrick, et. al. (2010). Accessibility of Primary  Health Care Settings for People with DisabilitiesStudy Data and Data Collection Procedures Unit of observation: primary care provider  physical facility Providers are with one of 5 health plans serving California Medicaid enrollees Data collected via on-site reviews, 2006-2010.(A review is conducted when the provider joins a plan, every three years thereafter) Instrument: 55 item add-on assessing disability access to required State of California Facility Site Review Total # of observations = 2389Mudrick, et. al. (2010). Accessibility of Primary  Health Care Settings for People with DisabilitiesCounty n %Los Angeles 1673 70.0San Bernardino 170 7.1San Diego 113 4.7Riverside 108 4.5Alameda 75 3.1Fresno 62 2.6Sacramento 55 2.3Orange 30 1.3Kern 29 1.2Kings, Madera, Merced, Placer, Stanislaus, Tulare, Yolo, San Joaquin, Contra Costa75 3.1Total 2389 99.9Counties of Health Plans in the Data SetMudrick, et. al. (2010). Accessibility of Primary  Health Care Settings for People with DisabilitiesCharacteristics of the Providers & SitesUrbanicity %Urban 94.8% (n=2265)Non-urban 5.2% (n=124)Primary Care Specialty* %General medicine 29.5% (n=502)Internal medicine 34.5% (n=587)Family practice 41.9% (n=713)Pediatrics 35.6% (n=606)Obstetrics &/or gynecology 5.2% (n=88)*Not all health plans were able to provide information on primary care specialties.  Percentages based on total of 1700 providers with specialty data. Mudrick, et. al. (2010). Accessibility of Primary  Health Care Settings for People with DisabilitiesADA Seniors and Persons with Disabilities Facility Site Review Assessment ToolCriterion Category# ofindicators Examples of IndicatorsParking 5 Number accessible spaces, signage, van accessible spaces, curb cuts for drives, parking & drop-offsRamps -Exteriors5 Landings are level, ramp length, ramp width, railingsStairways –Exterior2 Risers closed, handrails on both sidesEntrances to building5 Doorway opening, clearances, handles or pulls, alternateaccessible entrance, signageInterior circulation1 Floors on given story are level or connected by ramps, elevators, or liftsDoors – (to office) interior4 Opening & clearances, handles or pulls, force required to openRamps – Interior 3 Landings are level, ramp length, handrailsMudrick, et. al. (2010). Accessibility of Primary  Health Care Settings for People with DisabilitiesADA Seniors and Persons with Disabilities Facility Site Review Assessment Tool (cont.)Criterion Category# of indicators Examples of IndicatorsStairways –interior w/no elevators2 Closed risers, handrails both sidesElevators 10 Location, maneuver space, buttons, signage, intercom, used without assistance, reach rangesRestroom 11 Doors, handles & pulls, accessible & sufficient floor space(single or multi-user), grab bars, accessible toilet paper, faucets, & soap or other dispensersReception & waiting area1 Aisle, tables, and waiting areas with sufficient floor spaceExam & Treatment areas6 Accessible route, door openings, handles or pulls, floor space in examining rooms, height adjustable exam tables, accessible weight scaleTotal 55Mudrick, et. al. (2010). Accessibility of Primary  Health Care Settings for People with DisabilitiesAccess Categories for AnalysisAccess Category # of Criteria1)  Parking and Exterior Access 122)  Building Entrances & InteriorPublic Areas 213)  Interior of Provider’s Office(waiting area, exam & restrooms) 204)  Exam equipment (height adjustableexam tables, weight scales) 2Mudrick, et. al. (2010). Accessibility of Primary  Health Care Settings for People with DisabilitiesParking and Exterior Access to the Facility12 Indicators% ApplicableIndicatorsMeet Standard        % Cum %0 – 50% 6.3%         6.3%51 – 89%         36.7%       43.0%90 – 99%           4.2%       47.2%100% 52.8%     100.0% n=2384Mudrick, et. al. (2010). Accessibility of Primary  Health Care Settings for People with DisabilitiesHighlights: Parking & Exterior AccessAreas of Greatest Access (% Yes)Required ratio of accessible parking spaces: 94.3%Curb cuts at drives, parking, and drop-offs: 96.9%Where ramps are present, meet standards for landings, length, and width: 96.4%-98.8%Areas of Greatest Deficiency (% No)Presence  or ratio of van accessible spaces: 34.8%Signage for accessible parking not visible:  15.7%Handrails on both sides of ramp >6 ft: 19.7%Mudrick, et. al. (2010). Accessibility of Primary  Health Care Settings for People with DisabilitiesBuilding Entrances and Interior Public Areas21 Indicators% of ApplicableIndicatorsMeet Standard % Cum%0 – 50% 2.9% 2.9%51 – 89% 33.6% 36.5%90 – 99% 7.2% 43.7%100% 56.3% 100.0%n=2345Mudrick, et. al. (2010). Accessibility of Primary  Health Care Settings for People with DisabilitiesHighlights: Building Entrance and Interior Public AreasAreas of Greatest Access (% Yes) Entrance door ≥32” clear opening: 98.5% If elevators, near major path of travel, usable when building occupied: 98.8% If ramps or stairs, meet standards for landings, length, width, and handrails: 88%-96%Areas of Greatest Deficiency (% No) Signage on inaccessible entrances directing to accessible entrance: 40.1% Exterior door hardware: 17.5% If elevator, visible & audible door opening or closing & floor indicators: 30.7% Floor signage on both elevator door jambs: 22.1%Mudrick, et. al. (2010). Accessibility of Primary  Health Care Settings for People with DisabilitiesInterior of Provider’s Office20 Indicators% ApplicableIndicatorsMeet Standard % Cum %0 – 50% 6.4%         6.4%51 – 89% 40.5%      46.9%90 – 99% 18.8%      65.7%100% 34.3%    100.0%N=2388Mudrick, et. al. (2010). Accessibility of Primary  Health Care Settings for People with DisabilitiesHighlights: Interior of Provider’s OfficeAreas of Greatest Access (% Yes) Exam & treatment rooms on accessible route: 99.5% Door to physician office ≥32” clear opening: 96.9% Toilet paper dispensers are accessible: 98.1%Areas of Greatest Deficiency (% No) Door hardware: office door 32.6%; restroom door 31.1%; exam room door 36.5% Door weight: 20.2% Restroom: space in single &/or multi-user stall 13.3%-16.6% across 4 indicators Restroom: space under sink 15.3%; faucet type 18.9%Mudrick, et. al. (2010). Accessibility of Primary  Health Care Settings for People with DisabilitiesYes3.6%Accessible Weight ScaleYes8.4%Height Adjustable Exam Tablen=2367 n=2351Examination EquipmentMudrick, et. al. (2010). Accessibility of Primary  Health Care Settings for People with DisabilitiesUrban and Non-Urban DifferencesAccess Criterion% Not in ComplianceUrban            Non-UrbanInterior doors can be opened with force <5 lbs *20.7% 10.2%Restroom floor space allows 60” diameter circle or clear 56”X63” 17.0% 10.5%Doors to exam & treatment rooms ≥32” clear opening width *11.3% 5.6%Exam room allows 180° turn, no door swings into turning space *10.4% 2.4%Height adjustable exam table *92.2% 82.1%* p < .05Mudrick, et. al. (2010). Accessibility of Primary  Health Care Settings for People with DisabilitiesAccess Among Primary Care SpecialtiesPrimary Care Specialty% exam floor space clear% with AdjustableExam Table% with Accessible ScaleGeneral Practice  (n=502) 88.6% 8.4% 2.2%Internal Medicine  (n=587) 91.8% 12.1% 5.5%Family Practice  (n=712) 91.6% 11.9% 4.8%Pediatrics  (n=606) 91.7% 8.9% 5.8%Obstetrics/Gynecology(n=88)96.6% 18.4% 10.3%Mudrick, et. al. (2010). Accessibility of Primary  Health Care Settings for People with DisabilitiesSummary: Access Strong and WeakIndicators with high access compliance • Parking spaces (except van accessible)• Door widths• Paths of travel• Elevators, ramps, and stairsIndicators with lowest access compliance• Exam equipment• Restrooms: Door handles and latches, faucets, grab bars• Restrooms: Clear floor space at entry; toilet stall space for single or multi-user bathrooms• Signage: Exterior; in elevators• Doors (exterior & interior): Handle and latch operation; door weightMudrick, et. al. (2010). Accessibility of Primary  Health Care Settings for People with DisabilitiesCaveatData are restricted to elements of architecture and physical access, whereas information from patients and lawsuits indicate that there are significant problems in other areas.• Effective communication• Office procedures• Disability cultural competence• Medical staff attitudes• Accessible equipment (beyondscales and exam tables)Mudrick, et. al. (2010). Accessibility of Primary  Health Care Settings for People with DisabilitiesConclusions and Implications1) Many health care provider offices have physical barriers that can affect the quality ofhealth services provided to patientswith disabilities2) These barriers not only affect theservices provided, but may discourageothers from engaging in medical services for prevention and wellness3) This analysis shows that health plan site reviews are a feasible method for obtaining information on provider access characteristics

Accessibility of Primary Health Care Settings for People with Disabilities

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Accessibility of Primary Health Care Settings for People with Disabilities

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