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R2 Clinic Access Checklist Reliability Study

Principal Investigators: Charles Drum, JD, PhD; Charles Davis, MSW

This study will develop a checklist tool to evaluate the physical and programmatic accessibility of outpatient health care clinics based on the ADA. The tool will be tested to ensure that it is reliable, valid and useful. And it will be submitted to the U.S. Department of Justice for sufficiency review.

Hypothesis: A checklist for ADA Compliance for health clinic sites can be developed that will be reliable, valid and useful.

Study Design: Development and validation study of a tool to evaluate the physical and programmatic accessibility of outpatient health care clinics. Submission to U.S. Department of Justice for sufficiency review.

Sample: 1) clinical design elements from the ADA Accessibility Guidelines (ADAAG) and as summarized by the North Carolina, South Carolina, and Massachusetts Offices on Disability and Health (C. Graham, personal communication, July 29, 2004). 2) 30 selected outpatient clinics that vary in size and location to test reliability and validity of the tool.

Data Collection and Measurement: The ADA accessibility guidelines for medical facilities address exterior and interior spaces as well as equipment. To date there is no tool to systematically evaluate the level of compliance of outpatient health clinics to ADA guidelines.

Assessment Toll Design: The proposed assessment tool will provide a rating system that could be used by people with disabilities, health care staff, or researchers to determine the level of accessibility of an ambulatory care clinic. It will be developed using ADA Accessibility Guidelines and state and local building codes. These guidelines address fixed design elements of both exterior and interior spaces. The tool will be developed by a panel from the Northwest ADA & IT Center (the Region X DBTAC) with prior experience in the development of an ADA compliance tool for parking facilities. The panel will consult with other Disability and Business Technical Assistance Centers (DBTACS) and persons with disabilities to reach consensus on prioritization of the design elements from the guidelines. An independent design center and/or the Access Board will be consulted to prioritize a checklist of design elements in assessing medical equipment. The lists will be combined, and a panel of persons with a variety of different disabilities, including sensory, mobility, cognitive, will review and validate them. Modifications will be made based on the recommendations of persons with disabilities. The panel will design the assessment tool with consideration of the following factors: 1) prioritization of design elements (weighting scores on design elements to reflect the degree of accessibility they provide to the facility as a whole); 2) specific design elements that afford greater accessibility to people with specific impairments (e.g., sensory, cognitive, mobility); 3) domains of accessibility (e.g., parking lot, entrance, lobby, reception desk, restrooms, changing areas, examining and testing areas, equipment within each domain, and all accessible routes between domains); 4) a profile of scores for each design element vs. a total; 5) requirements for new construction and existing facilities; and 6) system of scoring that reflects the degree of accessibility of the facility overall and/or for different user groups. The assessment tool will be developed based on the recommendations of the panel and persons with disabilities and constructed to yield a score that reflects degree of accessibility. Independent raters who have received instruction in its use will perform the pilot test. They will independently assess 30 randomly selected outpatient health care clinics. Raters will record administration time, any difficulties encountered, feedback on their understanding of the tool items, and their satisfaction with the tool.

Data Analysis Methods: Inter-reliability on compliance ratings will be measured using the kappa statistic, which controls for expected agreement by chance on each criterion. Feasibility will be measured by administration time and difficulties with administration. Face validity will be assessed by collecting feedback from experts in the field, clinic staff and other potential users. The final version of the tool will be submitted to the U.S. Department of Justice for sufficiency review. If approved, DOJ approval will allow the tool to be disseminated by all federally-funded ADA technical assistance providers.

Anticipated Findings: A checklist for ADA Compliance for health clinic sites that is reliable, valid, useful, and legally sufficient. We anticipate the tool will be used to identify problem areas or problem clinics that need to be modified. It will be used as a research tool to quantify accessibility of health care facilities and will be used in R3.


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