An Implementation Guide for Healthcare Organizations
More than 1 in 4—or over 70 million—Americans have a disability.1 The Americans with Disabilities Act (ADA) defines a person with a disability as someone who has a physical or mental impairment that substantially limits one or more major life activities; has a history or record of such an impairment; or is perceived by others as having such an impairment.2 This can include mobility, communication, hearing, cognitive, visual, mental health or other disabilities, some of which may not be visibly apparent.
Federal civil rights laws, namely the ADA and Section 504 of the Rehabilitation Act of 1973, prohibit discrimination on the basis of disability.3-5 These laws generally apply to entities that serve the public or receive federal financial assistance, including hospitals, healthcare providers, and other healthcare organizations. Such organizations are mandated to provide full and equal access to care and services for people with disabilities.6
Despite the large population of Americans with disabilities and federal law mandating equal access to care, a growing body of literature finds that people with disabilities experience significant disparities in health and healthcare outcomes. For example, compared to non-disabled people, people with disabilities are more likely to have a greater number of chronic conditions and have higher rates of asthma, hypertension, emphysema, cardiovascular disease, diabetes, and arthritis.7 People with disabilities are also more likely to rate the quality of their health as fair or poor.8,9
While multiple factors contribute to poor health outcomes, inadequate access to high-quality care—despite high rates of health insurance—is a major barrier for people with disabilities. People with disabilities are more likely to report difficulty finding a clinician,7 and when they do access care, they report low satisfaction with the quality of care and communications they receive.7,10 Persistent disparities in cancer screenings such as colorectal cancer screenings,11 Pap tests,12 and mammographies13 exist, and a significantly larger percentage of people with disabilities have at least one hospitalization and emergency department visit within a year compared to people without disabilities.7
While significant progress has been made over the past 50 years, healthcare organizations—even the most well-intentioned—remain largely inaccessible and inequitable for people with disabilities.14 For example, clinics rarely have accessible equipment available, such as wheelchair accessible weight scales, and clinicians report rarely providing accommodations.15-21
We have found few comprehensive, evidence-based resources available to support healthcare organizations, clinicians, and staff in delivering high-quality care for patients with disabilities. This Implementation Guide seeks to fill this gap.
This Implementation Guide is based on existing data and learnings from healthcare organizations across the country that are working to improve the quality of care provided to patients with disabilities. This information is intended to provide guidelines which are adaptable to your local context.
The Guide is designed for healthcare organizations of all sizes, from small rural clinics to large health systems, and to be used by any role within an organization, from frontline staff and clinicians to executive leadership.
Each chapter provides step-by-step guidance for healthcare organizations to deliver high-quality care to people with disabilities across the following areas:
- Building a Disability Accessibility Program↗: Critical infrastructure and foundational components necessary to provide accessible care in your organization.
- Documenting Disability Status and Accommodation Needs↗: Collecting patients’ disability status and accommodation needs in the electronic health record.
- Providing Accommodations↗: Operationalizing the provision of disability accommodations during a patient’s healthcare visit or stay.
- Effective Communication↗: Implementing effective communication in the healthcare setting.
The “General Resources↗“ section contains a variety of materials referenced across the Guide’s chapters. Each chapter includes an introduction to its topic, actionable steps for implementation, and appendices containing tools and resources to utilize while completing each step. Every chapter is intended to be used independently depending on your organization’s needs.
- Centers for Disease Control and Prevention. Disability Impacts All of Us. Accessed November 11, 2025, https://www.cdc.gov/disability-and-health/articles-documents/disability-impacts-all-of-us-infographic.html
- Civil Rights Division, U.S. Department of Justice. Introduction to the Americans with Disabilities Act. Accessed November 11, 2025, https://www.ada.gov/topics/intro-to-ada/
- General Requirements; General prohibitions against discrimination. 45 CFR §84.68(a) (2024). Accessed March 31, 2026. https://www.ecfr.gov/current/title-45/part-84/section-84.68
- General Requirements; General prohibitions against discrimination. 28 CFR §35.130(a) (1991). Accessed March 31, 2026. https://www.ecfr.gov/current/title-28/part-35/section-35.130#p-35.130(a)
- General Requirements; General; Prohibition of discrimination. 28 CFR §36.201(a) (1991). Accessed March 31, 2026. https://www.ecfr.gov/current/title-28/part-36/section-36.201#p-36.201(a)
- Pacific ADA Center. Health Care and the Americans With Disabilities Act. ADA National Network. Accessed November 11, 2025, https://adata.org/factsheet/health-care-and-ada
- Stransky ML, Jensen KM, Morris MA. Adults with Communication Disabilities Experience Poorer Health and Healthcare Outcomes Compared to Persons Without Communication Disabilities. J Gen Intern Med. Dec 2018;33(12):2147-2155. doi:10.1007/s11606-018-4625-1
- Havercamp SM, Scandlin D, Roth M. Health disparities among adults with developmental disabilities, adults with other disabilities, and adults not reporting disability in North Carolina. Public Health Report. Jul-Aug 2004;119(4):418-26.
- Altman B, Bernstein A. Disability and health in the United States, 2001-2005. National Center for Health Statistics; 2008.
- Hoffman JM, Yorkston KM, Shumway-Cook A, Ciol MA, Dudgeon BJ, Chan L. Effect of communication disability on satisfaction with health care: a survey of medicare beneficiaries. Am J Speech Lang Pathol. Aug 2005;14(3):221-8. doi:10.1044/1058-0360(2005/022)
- Iezzoni LI, Kurtz SG, Rao SR. Trends in colorectal cancer screening over time for persons with and without chronic disability. Disabil Health J. Jul 2016;9(3):498-509. doi:10.1016/j.dhjo.2016.02.003
- Iezzoni LI, Kurtz SG, Rao SR. Trends in Pap Testing Over Time for Women With and Without Chronic Disability. Am J Prev Med. Feb 2016;50(2):210-9. doi:10.1016/j.amepre.2015.06.031
- Iezzoni LI, Kurtz SG, Rao SR. Trends in mammography over time for women with and without chronic disability. J Womens Health (Larchmt). Jul 2015;24(7):593-601. doi:10.1089/jwh.2014.5181
- Iezzoni LI, McKee MM, Meade MA, Morris MA, Pendo E. Have Almost Fifty Years Of Disability Civil Rights Laws Achieved Equitable Care? Health Aff (Millwood). Oct 2022;41(10):1371-1378. doi:10.1377/hlthaff.2022.00413
- Mudrick NR, Swager LC, Breslin ML. Presence of Accessible Equipment and Interior Elements in Primary Care Offices. Health Equity. 2019;3(1):275-279. doi:10.1089/heq.2019.0006
- Agaronnik N, Campbell EG, Ressalam J, Iezzoni LI. Communicating with Patients with Disability: Perspectives of Practicing Physicians. J Gen Intern Med. Mar 18 2019;34(7):1139-1145. doi:10.1007/s11606-019-04911-0
- Iezzoni LI, Rao SR, Ressalam J, Bolcic-Jankovic D, Campbell EG. Incidence of Accommodations for Patients With Significant Vision Limitations in Physicians’ Offices in the US. JAMA Ophthalmol. Jan 1 2022;140(1):79-84. doi:10.1001/jamaophthalmol.2021.5072
- Iezzoni LI, Rao SR, Ressalam J, Bolcic-Jankovic D. Accommodating hearing loss in outpatient physician offices in the U.S. Disabil Health J. Oct 19 2022:101397. doi:10.1016/j.dhjo.2022.101397
- Mudrick NR, Breslin ML, Liang M, Yee S. Physical accessibility in primary health care settings: results from California on-site reviews. Disabil Health J. Jul 2012;5(3):159-67. doi:10.1016/j.dhjo.2012.02.002
- Lagu T, Hannon NS, Rothberg MB, et al. Access to subspecialty care for patients with mobility impairment: a survey. Ann Intern Med. Mar 19 2013;158(6):441-6. doi:10.7326/0003-4819-158-6-201303190-00003
- Pharr JR. Accommodations for patients with disabilities in primary care: a mixed methods study of practice administrators. Glob J Health Sci. Jan 2014;6(1):23-32.
CHAPTERS
Chapter 1: Building a Disability Accessibility Program
Chapter 1: Building a Disability Accessibility Program was supported by the WITH Foundation under award number 233752. Under this award, an advisory board was convened to support the development of this chapter. Advisory board members included Zary Amirhosseini, Dr. Kara Ayers, Lindsay Baran, Sherri Rita, Dr. J.R. Rizzo, Adreinne Robertiello, Sarah Triano, Wendy Sultzman, Hope Collins, and Rebecca Zickerman.
We would also like to express our gratitude to Kori Eberle, Jennifer Halfacre, Lynne Brady Wagner, and Ellie Mellor for their contributions and review of this chapter. Additionally, we would like to thank the members of DEC’s Leaders workgroup and Standards & Guidelines workgroup for their input and suggestions.
Chapter 2: Documenting Disability Status and Accommodation Needs
The development of Chapter 2: Documenting Disability Status and Accommodation Needs was supported by the National Institute on Deafness and Other Communication Disorders of the National Institutes of Health under award number R01DC020188. We thank the members of the implementation mapping advisory board for their contributions to inform this chapter.
We would also like to express our gratitude to Kori Eberle, Jennifer Halfacre, Dr. Tina Studts, and Ellie Mellor for their contributions and review of this chapter. Additionally, we would like to thank the members of DEC’s Leaders workgroup and Standards & Guidelines workgroup for their input and suggestions.
Chapter 3: Providing Accommodations
The development of Chapter 3: Providing Accommodations was supported by the National Institute on Deafness and Other Communication Disorders of the National Institutes of Health under award number R01DC020188. We thank the members of the implementation mapping advisory board for their contributions to inform this chapter.
We would also like to express our gratitude to Kori Eberle, Holly Darnell, Dr. Carol Haywood, Jennifer Halfacre, Dr. Tina Studts, and Ellie Mellor for their contributions and review of this chapter. Additionally, we would like to thank the members of DEC’s Leaders workgroup and Standards & Guidelines workgroup for their input and suggestions.
Chapter 4: Effective Communication
Chapter 4: Effective Communication was supported by the WITH Foundation under award number 233752. Under this award, an advisory board was convened to support the development of this chapter. Advisory board members included Dr. Sarah Ailey, Max Barrows, Melanie Davis, Alex Friedman, Dr. Christopher Hanks, Patty McMahill, Dr. Dora Raymaker, and Kayla Rodriguez.
We would also like to express our gratitude to Kori Eberle, Tami Altschuler, Mary Bauer, Jennifer Halfacre, Regina McCollough, and Ellie Mellor for their contributions and review of this chapter. Additionally, we would like to thank the members of DEC’s Leaders workgroup and Standards & Guidelines workgroup for their input and suggestions.
Copyright (2026) Disability Equity Collaborative
Some Rights Reserved
Funding by the National Institute on Deafness and Other Communication Disorders (R01DC020188) and the WITH Foundation (233752)
Conflicts of Interest: All Developers – None
Last Update 04/02/2026
No part of this publication may be used in any commercial development or effort without the express prior written permission of the publisher. No part of this publication may be used in any derivative work without first obtaining permission from the publisher and providing acknowledgement thereof. The Disability Equity Collaborative hereby disclaims all liability associated with the use or adoption of the information provided herein. User shall remain liable for any damages resulting from reliance on this information. The content is solely the responsibility of the authors and does not necessarily represent the official views of funding agencies (NIH, WITH), New York University (NYU) Grossman School of Medicine, or NYU Langone Health. The material provided in this guide is intended for informational purposes only and is not provided as legal advice.
Large print version available upon request.
Additional chapters are in development.