Determining the relationships between provider bias, experiences of ableism, and health outcomes for people with mobility disabilities

Project Title: Determining the relationships between provider bias, experiences of ableism, and health outcomes for people with mobility disabilities Project Abstract Ableism, the act of discrimination and social prejudice based on presumed or actual impairment and/or disability, is a pervasive and insidious force in clinical healthcare. Emerging literature points to multiple factors that may contribute to ableism, however the mechanisms by which these factors impact the health outcomes of people with disabilities have not been widely explored. Critical knowledge gaps exist in understanding the relationships between lived experiences of ableism, biases of healthcare providers, and both short- and long-term health outcomes. People with disabilities are a heterogeneous group with unique experiences of ableism during healthcare encounters. As a first step towards investigating the mechanisms through which ableism impacts health outcomes, we will focus on people with mobility disabilities (PWMD), a disability group representing 1 in 7 adults. We will investigate ableism as a social determinant of health in the context of rehabilitative care, evaluating its impact on self-perceived health status, depression, anxiety, pain, participation, quality of life, and measures of healthcare utilization. Further, we will examine how provider biases and practices impact patient outcomes, a necessary step to address ableism at a systems level. This study will evaluate the relationships between self-perceived experiences of ableism, provider biases, and health outcomes among PWMD. We will conduct a mixed-methods, observational study with a sequential explanatory design with 40 rehabilitation providers and over 400 PWMD across two study sites in Pittsburgh, PA, and Seattle, WA. We will prospectively assess explicit and implicit disability biases of rehabilitation providers and then measure perceived ableism and health outcomes of PWMD during episodes of rehabilitative care (Aim 1). We will also evaluate the association between cumulative experiences of ableism and current self-reported health outcomes among PWMD at a second data collection session using measures distinct from those related to the episode of care (Aim 2a). Additionally, we will retrospectively analyze the electronic health records of our cohort using cutting edge Natural Language Processing technology to detect patterns of potential bias within provider documentation (Aim 2b). Finally, we will conduct qualitative semi-structured interviews with PWMD to understand the lived experiences of ableism across contexts of rehabilitation and general healthcare (Aim 3). Qualitative data will be used to contextualize quantitative results, map lived experiences to health outcomes, and generate new theories about the role of ableism in provider-PWMD relationships. The long-term goal of our work is to reduce disparities and maximize participation, health, and quality of life in partnership with PWMD. This work will leverage our team’s multidisciplinary expertise, lived experience of disability, and past work to fill a critical gap in understanding underlying mechanisms that perpetuate ableism in healthcare so that more effective bias-mitigating solutions may be developed and evaluated in the future.