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BACKGROUND: Patient-centered care for people with disability requires effective communication and compliance with the Americans with Disabilities Act (ADA). OBJECTIVE: To understand physicians' perspectives on communication experiences with people with disability. DESIGN: Twenty semi-structured individual interviews. Interview recordings were transcribed verbatim for analysis.

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Objective: To assess the utility of applying natural language processing (NLP) to electronic health records (EHRs) to identify individuals with chronic mobility disability. Design:We used EHRs from the Research Patient Data Repository, which contains EHRs from a large Massachusetts health care delivery system. This analysis was part of a larger study assessing the effects of disability on diagnosis of colorectal cancer. We applied NLP text extraction software to longitudinal EHRs of colorectal cancer patients to identify persons who use a wheelchair (our indicator of mobility disability for this analysis). We manually reviewed the clinical notes identified by NLP using directed content analysis to identify true cases using wheelchairs, duration or chronicity of use, and documentation quality. Setting: EHRs from large health care delivery system Participants: Patients 21-75 years old who were newly diagnosed with colorectal cancer between 2005-2017. Interventions: Not applicable Main Outcome Measure(s): Confirmation of patients' chronic wheelchair use in NLP-flagged notes; quality of disability documentation

Background: Many factors contribute to the well-recognized health care disparities experienced by persons with disability, including failure of physicians to understand the lives of individuals with disability. Disability cultural competence considers physicians' ability to meet the social, cultural, and linguistic needs of this population.Objectives: To assess physicians' understanding of disability cultural competence and attitudes towards patients with disability. Methods:Qualitative analyses of open-ended individual interviews averaging 41 minutes with 20 Massachusetts physicians from 5 different subspecialties, in practice for 8-51 years. Interview recordings were transcribed verbatim for conventional content analysis.Results: Most participants defined disability using medically-focused concepts rather than concepts that recognize how social factors contribute to disability. All participants used disability culturally-competent language, such as "person-first language," at some points throughout their interviews. However, most participants also employed language that is now considered unacceptable or archaic, such as variations on the word "handicap," "wheelchair-bound," describing persons with disability as "suffering," and calling persons by their health condition (e.g., "COPDer"). Participants mentioned persons with mental illness and intellectual disability as particularly challenging, especially around communication and performing even routine tests or examinations. Recommendations for improving care included better listening to patients with disability and seeking their views about their care.

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Disability civil rights laws require equitable treatment of the approximately sixty-one million Americans with disability. However, federal reports and numerous research studies indicate that this diverse and growing population often experiences health care disparities. To examine one possible contributing factor, we interviewed practicing physicians to explore their knowledge of their obligations to accommodate patients with disability under federal civil rights law. Interviewees reported having had little formal training about, and demonstrated superficial or incorrect understanding of, their obligations in three potentially problematic areas: deciding which accommodations their practices should implement, refusing patients with disability, and holding patients accountable for costs of accommodations. The fact that practicing physicians might not fully understand their legal responsibilities when caring for people with disability may contribute to persisting inequity in their care, and it suggests that further education in the Americans with Disabilities Act and other disability civil rights laws may be warranted.Healthy People 2010-the 2000 decennial federal review of national public health priorities 1 -introduced people with disability as a subpopulation whose members experienced systematic inequities in their health care. Subsequent federal reports and growing numbers of academic research studies have confirmed frequent disparities in care for people with disability. [2][3][4][5] The Americans with Disabilities Act (ADA) of 1990 protects the civil rights of people with disability, a population estimated at roughly fifty-seven million Americans as of 2010. 6 The number of Americans with disability has grown to an estimated sixty-one

Role of the Funder/Sponsor: Roche Pharmaceuticals had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication. Additional Contributions:We thank all patients and their families who were enrolled in this study.