Atchison, Christie

Chevinsky, Jennifer

Francis, Melanie R

Goodwin, Michael

Jain, Sweety, MD

McKoy, Norman, BS

Sabino, Judith, MPH, CDP

Thau, Matthew

Zegelbone, Phillip

English

Lehigh Valley Health Network: LVHN Scholarly Works

Lehigh Valley Health NetworkLVHN Scholarly WorksDepartment of EducationEnhancing Healthcare Access for Patients WithDisabilitiesMelanie R. FrancisLehigh Valley Health Network, melanie.francis@lvhn.orgMichael GoodwinLehigh Valley Health Network, Michael.Goodwin@lvhn.orgPhillip ZegelboneLehigh Valley Health Network, Phillip.Zegelbone@lvhn.orgChristie AtchisonLehigh Valley Health Network, Christie.Atchison@lvhn.orgMatthew ThauLehigh Valley Health Network, Matthew.Thau@lvhn.orgSee next page for additional authorsFollow this and additional works at: https://scholarlyworks.lvhn.org/educationPart of the Education Commons, and the Medical Education CommonsThis Poster is brought to you for free and open access by LVHN Scholarly Works. It has been accepted for inclusion in LVHN Scholarly Works by anauthorized administrator. For more information, please contact LibraryServices@lvhn.org.Published In/Presented AtFrancis, M., Goodwin, M., Zegelbone, P., Atchison, C., Thau, M., McKoy, N., Chevinsky, J., Sabino, J., Jain, S. (2015, October 31).Enhancing Healthcare Access for Patients With Disabilities. Poster presented at: Family Medicine Education Consortium AnnualMeeting, Danvers, Massachusetts.AuthorsMelanie R. Francis; Michael Goodwin; Phillip Zegelbone; Christie Atchison; Matthew Thau; NormanMcKoy BS; Jennifer Chevinsky; Judith Sabino MPH, CDP; and Sweety Jain MDThis poster is available at LVHN Scholarly Works: https://scholarlyworks.lvhn.org/education/100SkillLehigh Valley Health Network, Allentown, PennsylvaniaEnhancing Healthcare Access for Patients With DisabilitiesMelanie Francis, Mike Goodwin, Phil Zegelbone, Christie Atchison, Matthew Thau, Norman McKoy, Jennifer Chevinsky, Judith Sabino, MPH, CDP, Sweety Jain, MDPatients with disabilities present unique and diverse healthcare needs. Access to care is often limited by structural limitations communication barriers, comfort level, and resources within individual facilities. As the healthcare landscape shifts to emphasis on primary care, family and internal medicine offices offer the robust opportunity to model appropriate communication and facilities to this population.We proposed to study the current physical barriers, available resources, and communication skills, as they relate to the care of patients with intellectual and physical disabilities in a cohort of primary care practices. The study consists of two components: •  Internal audit of structural accessibility (administrative audit)    •  Staff-reported survey of knowledge, comfort, and resources when accommodating patients with disabilities (practice member survey)© 2015 Lehigh Valley Health NetworkAcknowledgements:The authors gratefully acknowledge USF Morsani College of Medicine SELECT Program, LVHN Department of Family Medicine, the Medical Home Project, Melanie Johnson, Kyle Shaak, and Douglas Wells.Figure 1. Practice Member Survey responses for Knowledge of Local Resources. Participants were asked to list local resources they were aware of for patients with disabilities. They were allowed to list up to five programs. This chart displays the percentage of participants who were able to identify between zero to five programs. Results are an aggregate of total responses.Assessment of Healthcare Access for Patients with Disabilities Twenty surveys were distributed to clinical, administrative, and clerical staff at seven primary care practices (N=140). Ninety-five anonymous staff surveys were collected, a response rate of 67.8% The data was analyzed for trends in physical readiness, knowledge of available community resources, and communication practices when encountering patients with disabilities. Data was further stratified in order to compare actual physical readiness to perceived barriers among the practice sites. Variation between the two could suggest opportunities to raise awareness and education to improve quality and care.Physical ReadinessThe administrative audit assessed actual facility accessibility and available practice resources as observed by the practice manager and the investigator. The audit revealed that practice sites were generally physically prepared to accommodate patients with disabilities. The majority of practices answered “No” to two of twelve questions (“Are curb sidewalk ramps aligned with crosswalks?”, and “is staff trained in moving patient with disabilities?”). A number of sites constructed after passage of the ADA likely contributes to the overall physical preparedness of practice sites. Educating staff on how to move patients with disabilities presents a cost effective and relatively simple way to improve care.Knowledge of ResourcesApproximately half of participants were unable to identify a local community resource that could provide assistance to patients with disabilities. Of those able to identify at least one resource, 53% had prior experience using the programs they listed. Further analysis of the data is expected to identify the local resources most commonly recognized, and will provide valuable information on ways to increase awareness of relevant community resources and improve utilization to improve quality and access of care for patients with disabilities.CommunicationSurvey response to communication tools ranged from rarely to often, with only one category reaching the “often” threshold.  We seek to educate these practices via training of the doctors, nurses, and staff. Specifically, we believe use of Patients with Disabilities as Teachers (PDAT) and “Patient Voices” video can provide significant improvements in raising confidence among staff and enhancing communication between staff members and patients with disabilities. Limitations to the study include lack of demographic information on survey participants, small convenience sample, inherent subjectivity of the self-assessment, and lack of validated survey.  Future directions are to improve the survey, expand the sample size, and educate the practices on opportunities to improve. We hope that general trends obtained from the survey will eventually help us to make recommendations to enhance quality and access to care at clinical sites across the Lehigh Valley Health Network.The purpose of this pilot project was twofold:  1  Assess the state of physical readiness, communication skills, and knowledge of local resources at various primary care sites within the Lehigh Valley Health Network2  Compare perception of available resources to the actual availability of resources at these clinical sites. The practice audit tool showed that practice sites were generally physically prepared to accommodate patients with disabilities. However, survey responses indicate that there is room for staff knowledge and skill improvements in patient transfers, communication and awareness of local resources. Contrasting physical preparedness to perceived limitations of practice sites through the staff survey revealed observations that could indicate a lack of communication or awareness of potential resources that could easily enhance access to care. Data gathered from this survey will be used for educational purposes at independent practices and for network-wide recommendation initiatives to improve access for patients with disabilities. Tool Data Data CollectionPractice Member Survey•  Facility accessibility•  Community resource knowledge and utilization•  Communication skillsetAnonymous survey completed by willing practice member participants. All clinical and non-clinical staff, administration, and providers are eligible participantsAdministrative Audit•  Facility accessibility•  Practice resourcesAudit tool completed by practice manager and medical student member of research team.  INTRODUCTIONPractice 5 Practice 6 Practice 7 Audit AnswerSurvey Yes %Survey No %Survey Not Sure %Audit AnswerSurvey Yes %Survey No %Survey Not Sure %Audit AnswerSurveyYes %SurveyNo %Survey Not Sure %Is the waiting room accessible to patients with mobility impairment? Yes 100.0% 0.0% 0.0% Yes 100.0% 0.0% 0.0% Yes 37.5% 50.0% 12.5%Are bathrooms wheelchair accessible? Yes 100.0% 0.0% 0.0% Yes 85.7% 0.0% 7.1% Yes 81.3% 18.8% 0.0%Is there enough space in exam rooms for 180 degree turn in wheelchair? Yes 54.5% 18.2% 27.3% Yes 42.9% 42.9% 14.3% Yes 56.3% 18.8% 25.0%Are there wheelchair accessible scales? Yes 100.0% 0.0% 0.0% Yes 42.9% 28.6% 21.4% Yes 68.6% 12.5% 18.8%Printed information available in Braille? No 36.4% 18.2% 45.5% No 14.3% 42.9% 35.7% No 0.0% 62.5% 37.5%Printed information available in large print? No 18.2% 27.3% 45.5% Not Sure 35.7% 42.9% 21.4% Yes 31.3% 50.0% 18.8%Patient information on cassette tape or cd? No 0.0% 45.5% 54.5% No 0.0% 42.9% 57.1% No 0.0% 56.3% 43.8%Sign language Interpreter Service (i.e. live, iPad) Yes 36.4% 18.2% 45.5% Yes 100.0% 0.0% 0.0% Yes 93.8% 6.3% 0.0%Longer encounter appointments to allow for extended communication for patients with intellectual or physical disability?No 54.5% 9.1% 36.4% Yes 28.6% 42.9% 28.6% No 43.8% 43.8% 12.5%DISCUSSIONCONCLUSIONMETHODSSurvey for Healthcare Providers, Nurses, and StaffThis 10 minute survey is part of a research study assessing healthcare access for patients with disabilities. This study is being conducted by Lehigh Valley Health Network, Department of Family Medicine and USF medical students. Your decision to complete this survey is voluntary. This survey is anonymous and confidential. If you have any questions or concerns about this survey, please contact XXX-XXX-XXXX. Please return this 2-sided survey in the self-sealing envelope to the sealed box located at the nurse’s srtation by 6/1/2015.Physical Readiness:                                                                            Yes          No               Not SureIs the waiting room accessible to patients with mobility impairment?Knowledge of Local Resources:                                                                          List 5 local resources (community, governmental, social organizations) you are aware of for patients with intellectual or physical disabilities. Indicate with an X whether you are familiar with the resource and/or have used the resource for support for patients with disabilities.Communication Skills:                                                                          Please indicate with an X how often you use the following skills when talking with patients with intelllectual or physical disabilities.Assessment of Healthcare Access for Patients with DisabilitiesFacilities and Resource Audit: Survey for Practice Managers and StudentsCommunication - Does your practice provide:                           Yes          No               Not SurePrinted information available in Braille?RESULTSASSESSMENT OF HEALTHCARE ACCESSThe practice member survey measures the participant’s perceptions of facility accessibility, knowledge and utilization of community resources, and communication skills.This portion of the assessment evaluates the number of local community resources that serve persons with disabilities that a practice member can identifyThe practice audit tool assesses actual facility accessibility through observation and collects data on practice resources for patients with disabilities. Surveys are anonymous and confidential. No participant identifiers or information is collected or recorded. Surveys are coded to identify practice, but not participant. Site specific identified data is not reported in dissemination of research. Data is reported in aggregate.A primary aim is to measure facility accessibility, community resource knowledge, primary communication skills of staff and practice resources.  Through this assessment, it is hypothesized that gaps in accessibility, knowledge and skills will be identified. ]]]]]Table 1. Administrative Audit performed by investigator and Practice Manager at seven practice sites. Results are aggregated and used to assess actual physical preparedness to accommodate patients with disabilities. Graph is stratified into 100% compliance (white), between 50-100% compliance (yellow) and less than 50% (red).Table 3. Observed physical preparedness compared to perceived preparedness of survey participants at three of seven clinical practice sites. Results are an aggregate of total responses. Disparity between the two can be used to show trends and potential opportunities to raise educational awareness. Physical Readiness - Does your practice provide:  No YesSidewalk Curb Ramps - Existing? 0% 100%Is the waiting room accessible to patients with mobility impairment? 0% 100%Are bathrooms wheelchair accessible? 0% 100%Are handrails present in bathrooms? 0% 100%Are restroom accessories appropriate height for wheelchair? 0% 100%Sidewalk Curb Ramps - Flush with gutter or street? 14% 85%Are automatic door openers at an appropriate height? 14% 85%Is there enough space in exam rooms for 180 degree turn in wheelchair? 14% 85%Sidewalk Curb Ramps - visible? (clearly demarcated with signs) 42% 57%Are there wheelchair accessible scales? 42% 57%Are there staff trained in moving patients with disabilities? 57% 42%Sidewalk Curb Ramps - Aligned with crosswalk? 71% 28%   Never Rarely Sometimes Often Always Mean SDHow often do you speak directly to the person with the disability rather than to the companion or sign language interpreter?0.0% 13.0% 27.2% 31.5% 28.3% 3.75 1.012How often do you position yourself to eye level with a person using a wheelchair or crutches?4.3% 2.2% 20.7% 31.5% 41.3% 4.03 1.053How often so you put patients in  your practice into contact with local resources for disability services?15.1% 33.7% 29.1% 22.1% 0.0% 2.58 1.000How often do you provide information/pamphlets/brochures on resources for patients with disabilities?17.4% 40.2% 20.7% 16.3% 5.4% 2.52 1.124How often does your practice provide support and/or information on transportation services for patients with disabilities?11.6% 15.1% 40.7% 26.7% 5.8% 3.00 1.063  Table 2. Practice Member Survey responses for communication readiness. Participants were given 5 options, ranging from “Never” to “Always” that emphasized communication preparedness when dealing with patients with disabilities. Results are an aggregate of total 

Enhancing Healthcare Access for Patients With Disabilities

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Enhancing Healthcare Access for Patients With Disabilities

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