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
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
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.