Background: Health-related social needs (HRSN) are social and economic conditions that adversely affect health. Housing instability, food insecurity, and unreliable transportation may influence decisions during hospitalization, including care transitions. Numerous screening tools have been implemented in ambulatory and emergency care settings to capture HRSN and guide coordination of care. However, disability, which has profound implications for care coordination and delivery, is not usually documented as part of these efforts. More than 67 million community-dwelling adults in the United States have a disability. Persistent barriers to health care for people with disabilities (PWD) – including physical and procedural inaccessibility, and provider knowledge and attitudes – contribute to higher rates of morbidity and mortality and increased reliance on hospitals and emergency departments for routine care, when compared to people without disabilities. Research in outpatient settings demonstrates that physicians are often unaware that patients have disabilities and are unprepared to care for PWD. There are few studies of prevalence of disabilities in inpatient settings. We hypothesize that a significant proportion of hospitalized patients may have disabilities, but no prior research has characterized this demographic in acute care, or whether healthcare team members are aware of their patients’ disabilities and accommodations are reliably made. Given the vulnerability of this population, our objective was to survey hospitalized patients for disability status and related accommodation needs in tandem with efforts to screen for HRSN.
Methods: Patients hospitalized on general medicine services at a single tertiary academic medical center were approached by research staff on days 2-3 of their stay. With consent, a structured interview was administered to patients to assess HRSN, disability status, and related accommodation needs. Following patient enrollment, associated healthcare team members (advanced practice providers [APP]/physician/nurses) were administered a structured interview assessing their awareness of their patient’s disability status. All interview responses were directly entered by research staff into REDCap.
Results: 202 patients (70.4% of those approached) completed the survey. Of these, 65.8% self-reported disability (15.3% communication , 12.9% vision , 44.1% mobility , 26.7% cognition ); 45.0% reported use of an assistive device or adaptive equipment , and 30.7% required assistance for daily needs . Among the 133 patients who self-reported disability, 56.4% also reported one or more HRSN. At least one member of the care team completed a survey for 160 (79.2%) of enrolled patients; among those cases, 40.6% of APP/physicians and 54.5% of nurses were aware of their patients’ disabilities, and 36.9% reported that their patient’s disability status would influence the care they provided.
Conclusions: A majority of hospitalized patients self-reported disability, and in many cases, their disability was otherwise unknown and unaccommodated by healthcare teams. Screening for disability alongside HRSN was well-accepted among hospitalized patients. Results indicate a ready opportunity to improve care for PWD and other vulnerabilities linked to HRSN through routine assessment of individual needs and communication within the healthcare team.