How EHR Surveys Could Boost Patient Experience for People with Disabilities

EHR-based accessibility questionnaires could help improve the patient experience and advance health equity for people with disabilities, according to a study published in JAMA Network Open.

Researchers created and implemented an EHR questionnaire at an academic eye clinic to document patient accessibility requests.

Call center and front-desk staff assessed accessibility requests of patients making appointments over the phone or in-person and recorded patient responses in the EHR.

The study found that 9.4 percent of patients making eye care appointments reported having an accessibility request. The most-reported accessibility request was mobility-related, followed by sensory-related and intellectual-related needs.

Compared with the 9.4 percent of all patient encounters where a patient made an accessibility request, only 5.2 percent of patients reported having an accessibility request during their first visit.

This finding suggests that patients with disabilities were more likely to answer the EHR questionnaire while making an appointment, the researchers said.  

The study also revealed modest differences based on the geographic location of the clinic.  

More patients reported accessibility requests at the larger, hospital-based eye clinics than the smaller satellite clinics (11 percent vs. 9 percent, respectively).

The study authors said their finding suggests that more patients with disabilities use the larger clinics. Alternatively, it could be that patients with disabilities are more likely to request assistance in more crowded and complex settings. For instance, parking garages are farther away from the clinic in the downtown hospital setting, which likely compounded accessibility requests, the researchers explained.

“This questionnaire provides the infrastructure to collect accessibility requests, and such standardization of data collection can be scaled to other departments and clinical settings, with the potential to improve patient interaction and care,” the study authors wrote.

The researchers emphasized that EHR-based accessibility questionnaires could ultimately help advance health equity for people with disabilities.

Previous research has found that people with disabilities experience more difficulty accessing healthcare and have lower preventive screening rates than people without disabilities. People with disabilities are also more likely to delay or be unable to get needed dental care or prescription medications than people without disabilities.

“To provide equitable access to navigate healthcare systems, we need to develop and implement better systems that measure and address accessibility requests for people with disabilities,” the researchers wrote.

“Future research is needed to assess whether accessibility requests are being met and the effectiveness of the questionnaire in improving healthcare accessibility, interactions, and outcomes for people with disabilities,” they concluded.

The authors pointed out that the study did not identify all patients with disabilities. Instead, it determined the proportion of patients with disabilities who indicated a need for accommodations.

“Not all patients with disabilities have accessibility requests,” they wrote. “Some patients with disabilities may not need an accommodation, others may be familiar with the clinic setting and provide their own accommodation, and some patients with disabilities may be hesitant to make an accessibility request.”