Table 1.

Studies addressing quality of health care delivery and disparities in persons with disabilities (PWD).

Authors (Year)	Design and Sample	Intervention or Major Aim	Outcomes
Medical Education and Medical Student Perceptions, Attitudes and Comfort Level Working with PWD
Symons et al, 2014 [21]	Non-randomized controlled study Rx: Medical students enrolled in public medical school with disparities curriculum C: Medical school students from similar institution	Rx: Disabilities curriculum integrated across all four years of study—includes lectures on disability and society, communication with PWD, small group encounters with PWD, precepted clerkship in clinic for PWD, 1/2 workshop on legal and socioeconomic context of caring for PWD, and potential 4-week elective on primary care for PWD	Students in the intervention group reported better attitudes and higher comfort level working with PWD in the following areas: greater comfort working with PWD when someone else is with them (p = 0.008); more positive attitudes towards PWD and perceptions of PWD (p = 0.001). However, male students in the Rx group who encountered PWD in a clinical context had a tendency to agree with more negative statements about PWD
Medical Education and Medical Student Perceptions, Attitudes and Comfort Level Working with PWD
Brown et al, 2010 [19]	Quasi-experimental 146 3rd year medical students engaged in family medicine clerkship	Students engaged in 1 of 3 standardized patient (SP) experiences (1) patient without disability (n = 63); (2) patient with spinal cord injury (SCI) (n = 40); (3) patient with intellectual disability (ID) and his/her caregiver (n = 53)	Students involved in the OSCE with patients with SCI scored lower on history taking, physical exam, ordering of lab tests and interpersonal skills. Ordering of hemoglobin was higher among patients who did not have a disability (OR = 4.16; 95% CI = 1.78–9.17), ordering urinalysis was 3 times higher (OR = 3.08; 95% CI = 1.34–7.08) and oviding lifestyle counseling was 2 times higher (OR = 2.15; 95% CI = 1.04–4.44)
Moroz et al, 2010 [20]	Quasi- experimental Rx: 11 PMR residents C: 10 psychiatry residents engaged in standard	Rx: 7-h one day training including didactic lectures, panel presentations covering: disability facts; stories of experiences with medical care from PWD; information and skills on medical evaluation of disability. Following these didactic experiences students were assigned to a play the role of a PWD in a wheelchair or as a caretaker in structured simulations and debriefing sessions. C: Standard medical training	Students demonstrated significant improvements in disability knowledge and more positive attitudes towards PWD. Knowledge in sensitivity training did not persist at 3 months but positive attitudes toward PWD did.
Iezzoni et al, 2005 [18]	Focus group study Medical students during final year of study	Focus groups lasted 2 h	Students reported negative views of living with a disability, expressed admiration for PWD who are coping well, most drew their perceptions of PWD from family experiences, students voiced negative attitudes towards a subgroup of PWD, those who are obese and reported morbidly obese patients are responsible for their health status. Students also reported taking short cuts to save time and deal with busy schedules but did not realize this may impact their interactions with PWD.
Patient and Provider Perceptions of Health Care and Outcomes
O’Day et al, 2005 [24]	Focus group 16 patients with psychiatric disabilities in a psychiatric rehabilitation program	Focus group lasted two hours to examine patient perceived barriers to care	PWD reported trouble finding a primary care physician with good communication skills, receiving inadequate information about medication side effects, lack of understanding of their health condition, excess costs due to inadequate health insurance.
Patient and Provider Perceptions of Health Care and Outcomes
Bachman et al , 2006 [23]	Cross-sectional survey 379 health care providers from managed care organizations	No intervention	Providers more likely to provide care to patients with chronic illnesses, mobility, cognitive or psychiatric disabilities than those with communication disorders or visual impairments. Providers reported those with communication disorders are the most difficult to medically manage. The majority perceived PWD do not have easy access to medical care.
Morrison et al, 2008 [25]	Focus groups 27 health professionals and 19 adults with disabilities	Focus groups of PWD and providers	Both groups reported primary care providers need more education about PWD, improved education regarding communication and interpersonal skills, improved physical access at clinical sites, more flexible and accessible schedules for medical appointments.
Mudrick et al, 2011 [17]	Cross-sectional survey of provider sites conducted by nurses employed by different state health plans	No intervention	Barriers for PWD included physical barriers in bathrooms, examination tables, parking access, and access to buildings. 3.6% had an accessible weight scale and 8.4% had height accessible exam tables.
Lagu et al, 2013 [22]	Cross-sectional survey of 256 endocrinology, gynecology, orthopedic surgery, dermatology, urology, ophthalmology, otolaryngology, and psychiatry practices	Researchers posed as a fictional patient who was obese and had hemiparesis, used a wheelchair and could not transfer without assist	56 (22%) practices reported they could not accommodate the patient, 9 (4%) buildings were inaccessible, 47 (18%) reported they could not transfer the patient to an exam table and 22 (9%) had height adjustable tables or lifts for transfer. Of all practices, gynecology offices were the least accessible

Rx = treatment group; C = control group; OSCE = Objective structured clinical exam; PMR = Physical medicine and rehabilitation.