Implementation of Communication Disability Documentation and Accommodations in Primary Care: A Pragmatic Type III Hybrid Implementation-Effectiveness Trial Protocol.

In 30 seconds

This article describes the protocol for the DECA study, a pragmatic Type III hybrid implementation-effectiveness trial of communication disability (CD) documentation and accommodation processes in primary care. In a quasi-experimental stepped-wedge design, 10 clinics across five health systems will receive a tailored implementation guide and practice facilitation. The intervention supports recording patients’ CD status and accommodation needs in the electronic health record and providing requested accommodations. The primary outcome is the proportion of patients with clinic visits whose CD status is documented; secondary outcomes include accommodation documentation and qualitative assessments of adoption, implementation, and maintenance. The study has not yet reported effectiveness results.

Key findings

• The protocol includes 10 clinics across five health systems in a quasi-experimental stepped-wedge design.
• The primary outcome is the proportion of patients with clinic visits during the study period who have CD status documented in the electronic health record.
• The study rates its design elements as moderately to highly pragmatic using PRECIS-2-PS, with trade-offs between real-world applicability and scientific rigor.

Why it matters

Routine documentation of communication disability and accommodation needs may help health systems identify patients who need communication support and monitor disparities. This protocol evaluates an implementation approach in primary care settings, where such information is not routinely collected in many health systems. Its findings may clarify whether practical implementation support can improve documentation and accommodation processes.

What to keep in mind

This is a study protocol and reports no implementation or effectiveness results.