title: Rethinking quality in the context of persons with disability.
abstract: OBJECTIVE
  To review the current health services literature related to quality of care for persons with disabilities and to highlight the need for a unique framework for conceptualizing quality and patient safety issues for this population.
  
  
  METHODS
  Drawing on quality measurement theory, we formulate a multi-dimensional model of quality of care for persons with disability. This model is then used to identify and summarize findings from existing health services research that relate to the quality, of care for persons with disability.
  
  
  METHODS
  We searched MEDLINE and other databases for primary research and review articles containing the phrases 'quality of care', 'patient safety', 'access', 'patient experience', and 'coordination of care' in conjunction with the words 'disability' or 'impairment'.
  
  
  RESULTS
  A review of health services research suggests several potential issues in the areas of clinical quality, access, client experience, and coordination. Physical barriers, transportation, communication difficulties, and client and provider attitudes present barriers to receiving appropriate client-centered care. Communication difficulties between provider and client may increase risk for accidental injury and decrease the quality of the client experience. Frequent contact with the health care system and the complexity of an individual's situation also increase the risk of accidental injury. Coordination, the 'lubricant' that facilitates links for all areas of quality for a person with disability, presents the most significant opportunity for improvement, because multiple medical and social providers are typically involved in the care of individuals with disabling conditions.
  
  
  CONCLUSIONS
  Health care providers need to embrace a multi-disciplinary approach to quality to meet the needs of persons with disabilities. Funders and purchasers need to provide flexibility in funding to enable a comprehensive primary care approach, while health service researchers need to adopt a broad view of quality to capture issues of importance for persons with disabilities.
authors.affiliation: Center for Health Policy and Research, University of Massachusetts Medical School, Shrewsbury, MA 01545, USA. ann.lawthers@umassmed.edu
authors.forename: A G
authors.initials: AG
authors.lastname: Lawthers
authors.forename: G S
authors.initials: GS
authors.lastname: Pransky
authors.forename: L E
authors.initials: LE
authors.lastname: Peterson
authors.forename: J H
authors.initials: JH
authors.lastname: Himmelstein
mesh_terms: D003144:Communication Barriers; D003266:Continuity of Patient Care; D006233:Persons with Disabilities; D006297:Health Services Accessibility; D006301:Health Services Needs and Demand; D017146:Models, Organizational; D017060:Patient Satisfaction; D011785:Quality Assurance, Health Care / Q000379:methods*