Quality of Care/Patient Safety

People with disabilities are generally satisfied with their care but report poor communication and lack of thorough care

People with impaired vision, hearing, or mobility confront special physical and communication challenges in the medical setting. Patients who have disabilities are generally satisfied with the care they receive, but they are significantly more likely than other patients to report poor communication with care providers and lack of thorough care, regardless of the disabling condition, according to a recent study supported by the Agency for Healthcare Research and Quality (HS10223).

Thoughtful systematic approaches are needed to improve communication with disabled patients and to reduce time pressures that might compromise their health care experiences, concludes Lisa Iezzoni, M.D., of Beth Israel Deaconess Medical Center.

Dr. Iezzoni and her colleagues identified people with disabling conditions by using a 1996 nationally representative survey of 16,403 community-dwelling elderly and disabled Medicare beneficiaries. They controlled for demographic characteristics and managed care membership in predicting patient dissatisfaction with 12 dimensions of care quality.

Roughly 98 percent of those with and without disabilities believed their physicians were competent and well trained. But significantly more people with disabilities reported dissatisfaction with care for 10 of the 12 quality of care dimensions. People reporting any major disability were more than twice as likely as other people to be dissatisfied with physicians completely understanding their conditions, thoroughly discussing their health problems, and answering all their questions, and they were more likely to state that their physicians often seemed hurried.

See "Quality dimensions that most concern people with physical and sensory disabilities," by Dr. Iezzoni, Roger B. Davis, Sc.D., Jane Soukup, M.Sc., and Bonnie O'Day, Ph.D., in the September 22, 2003, Archives of Internal Medicine 163, pp. 2085-2092.

Editors Note: Two other AHRQ-supported articles recently addressed other aspects of quality of care. They examined varied hospital actions to increase beta-blocker use following heart attack and efforts to improve communication in the intensive care unit (ICU) to reduce ICU stays.

For more details, see:

• Bradley, E.H., Holmboe, E.S., Wang, Y., and others (2003, August). "What are hospitals doing to increase beta-blocker use?" (AHRQ grant HS10407). Joint Commission Journal on Quality and Safety 29(8), pp. 409-415.
• Pronovost, P., Berenholt, S., Dorman, T., and others (2003, June). "Improving communication in the ICU using daily goals." (AHRQ grant HS11902). Journal of Critical Care 18(2), pp. 71-75.

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