Disparities in health persist for people with disabilities (PWD). For example, according to the National Spinal Cord Injury Statistical Center, each year 1/3 to 1/2 of all people with spinal cord injuries are re-admitted to the hospital. Among individuals with hearing loss significant enough to cause communication difficulties, Chang et al., 2018 found that they have a 32% greater risk of readmission compared to their hearing peers. Quality indicators have improved for non-disabled patients but PWDs have not benefitted from these efforts. The 2013 National Healthcare Disparities Report from the Agency for Healthcare Research and Quality, over 60% of quality indicators, such as measures of patient-centered care and access to care, had improved for non-disabled people, whereas only 20-35% had improved for PWDs. Despite substantial disparities for PDW’s, few educational and training programs are available for those interested in disability focused research. MDisability within the Department of Family Medicine (DFM) intends to tackle these issues under the research aim. Our DFM researchers in the past 5 years have obtained nearly $7 million in funding to study a variety of disability health topics.
Early Audiology Referral in Primary Care (EAR-PC): Improving Detection of Hearing Loss
Philip Zazove, M.D., Principal Investigator
Funded by the National Institutes of Health, National Institute on Deafness and Other Communication Disorders, Department of Health and Human Services ($1,624,469)
Dr. Zazove is lead investigator of this R21/R33 study, which seeks to increase hearing loss screenings for patients 55 and older by utilizing electronic clinical management tools in primary care setting and multimedia. The MiChart research team has designed a Best Practice Alert (BPA) which notifies primary care providers (PCPs) of HL assessment opportunities and allows clinicians to refer directly and efficiently to audiology specialists. The multimedia project, guided by Micheleen Hashikawa, M.D., also created a video to address physicians’ mental models of hearing loss. The investigation has expanded to look at patients’ decision-making around hearing testing and adoption of hearing aids. The EAR-PC study has partnered with the Beaumont Family Medicine network and Elie Mulhem, M.D., Associate Professor, Oakland University William Beaumont School of Medicine to successfully include 5,500 patients in the pilot study. Dr. Zazove anticipates over 20,000 patients in the R33 phase.
The research is guided by three aims, to:
Evaluate whether the EAR-PC program increases PCP identification of patients with mild to moderate HL compared to baseline data.
Evaluate whether the EAR-PC program increases appropriate PCP referral of patients with mild to moderate HL to audiology specialists.
Utilize both qualitative and quantitative inquiry to investigate how successful PCPs implement the intervention, identifying processes and tools that will allow this project to successfully scale
Investigating Disability factors and promoting Environmental Access for Healthy Living (IDEAL) (IDEAL) Rehabilitation Research and Training Center
Michael M. McKee, M.D., M.P.H., Co-Investigator
Elham Mahmoudi, Ph.D., M.B.A., Co-Investigator
A $4.3 million grant will help establish a Rehabilitation Research and Training Center at the U-M and Michigan Medicine. Disability researchers Michael McKee and Elham Mahmoudi will establish new research and a model clinic in this large-scale effort.
Read the full grant announcement
Medical School Technical Standards and Compliance with the Americans With Disabilities Act
Physician diversity improves care for underserved populations, yet there
are few physicians with disabilities.
The authors examined the availability of technical standards (TSs) from U.S. medical schools (MD- and DO-granting) and evaluated these relative to intent to comply with the Americans with Disabilities Act (ADA).
Document analysis was conducted (2012–2014) on U.S. medical schools’ TSs for hearing, visual, and mobility disabilities. Primary outcome measures were ease
of obtaining TSs, willingness to provide reasonable accommodations, responsibility for accommodations, and acceptability of intermediaries or auxiliary aids.
TSs were available for 161/173 (93%) schools. While 146 (84%) posted
these on their Web sites, 100 (58%) were located easily. Few schools, 53 (33%), had TSs specifically supporting accommodating disabilities; 79 (49%) did not clearly state policies, 6 (4%) were unsupportive, and 23 (14%) provided no information. Most schools, 98 (61%), lacked information on responsibility for providing accommodations, 33 (27%) provided accommodations, and 10 (6%) had students assume some responsibility. Approximately 40% allowed auxiliary aids (e.g., motorized scooter), but < 10% allowed intermediaries (e.g., sign language interpreter). Supportive schools were more likely to allow accommodations (P < .001), assume responsibility for accommodations (P < .001), and accept intermediaries (P < .002). DO-granting schools were more supportive for students with mobility disabilities.
Most medical school TSs do not support provision of reasonable accommodations for students with disabilities as intended by the ADA. Further study is needed to understand how schools operationalize TSs and barriers to achieving ADA standards.
This was published. Zazove P, Case B, Moreland C, Plegue MA, Hoekstra A, Ouellette A, Sen A, Fetters MD. U.S. Medical schools’ compliance with the Americans with Disabilities Act: Findings from a national study. Academic Medicine: July 2016 - Volume 91 - Issue 7 - p 979–986. doi: 10.1097/ACM.0000000000001087
Mechanisms of Health Literacy and Information Accessibility in the Deaf
Michael M. McKee, M.D., M.P.H., Principal Investigator
Funded by the NIH, Department of Health and Human Services ($3,069,270)
The overall objective of the Health Information & Literacy study is to elucidate the role of information marginalization on health literacy in Deaf American Sign Language (ASL) users and to better understand the mechanisms of health literacy in this population. The study also seeks to identify viable targets for future health literacy interventions, particularly how visual learners may access, interpret, and act on existing health information.
Mi Health Mi Choice: Improving Contraceptive Care for Women With Medical Conditions
Justine P. Wu, M.D., M.P.H., Principal Investigator
Funded by National Institutes of Health (read more on Dr. Wu's award)
Adult women with chronic conditions have a higher rate of unintended pregnancy than adult women without chronic conditions. Chronic conditions and unintended pregnancy are both associated with pregnancy-related complications and adverse maternal and child health outcomes. Prior studies show that women with chronic conditions are not receiving adequate contraceptive counseling, particularly regarding highly effective contraceptive methods. There is an urgent need to improve contraceptive counseling and services for women with chronic conditions in order to decrease the rate of unintended pregnancy and improve reproductive health outcomes among this population.
This mixed methods, multi-phase study will first 1.) identify key factors on the patient-, provider-, and practice-level that are critical to the design of a contraceptive intervention for women with chronic conditions in primary care. The research team, led by Wu, will then develop an interactive, web-based contraceptive decision aid for women with chronic conditions, their PCPs, and implementation in primary care. Finally, a pilot randomized controlled trial (RCT) will be conducted to measure the feasibility of the decision aid as a potential large-scale intervention.
Protocol Citation: Wu JP, Damschroder LJ, Fetters MD, et al. A Web-Based Decision Tool to Improve Contraceptive Counseling for Women With Chronic Medical Conditions: Protocol For a Mixed Methods Implementation Study. JMIR Research Protocols. 2018;7(4). doi:10.2196/resprot.9249.
Parents Empowering Parents: National Research Center for Parents with Disabilities and their Families
Michael M. McKee, M.D., M.P.H., Co-Investigator Funded through the National Institute of Disability, Independent Living, and Rehabilitation Research It is a 5 year project. We will be conducting different studies to determine ideal approaches to empower and support parents with various disabilities. This will include a community-health care- research stakeholder meeting to discuss potential barriers and facilitators parental peer support program prior to the development of a novel online parental peer program that is accessible for parents with various disabilities. Dr. McKee's focus will be on providing input on ideal approaches to assist parents who are Deaf or hard of hearing.
Pregnancy Outcomes And Experiences Among Deaf And Hard Of Hearing Women
Michael M. McKee, M.D., M.P.H., Co-Primary Investigator Funded by the National Institutes of Health
Along with the the Lurie Institute for Disability Policy at Brandeis University, co-Principal Investigator Michael M. McKee will lead a five-year NIH-funded study of perinatal care and pregnancy outcomes for women who are Deaf and Hard of Hearing (DHH). This pioneering study seeks to fill a critical knowledge gap. While women who are Deaf and hard of hearing are equally likely to be pregnant as women with other disabilities and women without disabilities, almost no research exists about their pregnancy experiences, maternal and birth outcomes, or associated healthcare costs.
This study will provide the first-ever systematic understanding of pregnancy care costs and health outcomes for DHH women. With it, Mitra and McKee hope to establish the foundational knowledge necessary to develop future interventions to improve outcomes. They also plan to generate practice recommendations for clinicians to deliver improved perinatal health to DHH mothers and their infants.
Mothers who are deaf or hard of hearing who have given birth within the past 10 years, please see our study website, and check if you are eligibility to complete our confidential survey. Click here for a video in ASL explaining recruitment for the study.
Research Education and Training
Students Suhas Kellampalli, Blessed Mbogo and Ariana Nigoghosian interact with family medicine departmental faculty; learn healthcare accommodations for people with disabilities; and complete in-depth research projects.