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

Abstract

PURPOSE: Routine collection of patients' communication disability (CD) status is instrumental for monitoring and addressing health disparities, including the provision of disability accommodations. Few health systems routinely collect patients' CD status. This article describes the study protocol for the "Documentation of Communication Disability Collection and Accommodations in Primary Care Settings" (DECA) study, a pragmatic Type III hybrid implementation-effectiveness trial evaluating an implementation guide and practice facilitation on the adoption of CD status documentation. We additionally evaluate the study's pragmatic design using Pragmatic Explanatory Continuum Indicator Summary-2-Provider Strategies (PRECIS-2-PS). METHOD: The intervention includes documenting CD status and accommodation needs in the electronic health record (EHR) and providing requested accommodations. The implementation strategies are a tailored implementation guide and a practice facilitator providing implementation planning, problem solving, and quality monitoring. This quasi-experimental, stepped-wedge design includes 10 clinics across five health systems. The study employs a concurrent mixed-methods design. The primary outcome is Reach, operationalized as the proportion of patients with clinic visits during the study period who have CD status documented in the EHR. Secondary outcomes include the percentage of patients with accommodations documented in the EHR and the qualitative evaluation of adoption, implementation, and maintenance. Using PRECIS-2-PS domains, we rated the DECA study design elements as moderately to highly pragmatic, with design trade-offs made to balance real-world applicability with scientific rigor. CONCLUSION: The DECA study will offer pragmatic evidence on the implementation effectiveness of an implementation guide and practice facilitation supporting health systems in identifying which patients have a CD and what accommodations they need. SUPPLEMENTAL MATERIAL: https://doi.org/10.23641/asha.33967966.

The authors' abstract, as published at the source. Journal of Speech Language and Hearing Research, 2026 · DOI ↗