This multi-methods-multi-site study aims to adapt and evaluate the effects of an implementation support package of strategies to assist primary care clinics in documenting patients' communication disability (CD) and accommodation needs in the electronic health record (EHR) and providing communication accommodations through EHR data extraction, surveys, focus groups, interviews, and clinical practice observations.

Inclusion Criteria:

EHR Data Extraction

1. Adults 18+ years
2. Patients who had at least one visit within the 21-month EHR data collection period at participating study clinics.

Clinic Leadership, Providers & Clinic Staff

1. Adults 18+ years
2. Individuals of all genders and members of all racial and ethnic categories employed at participating study clinics will be eligible for inclusion. NYULH study personnel will enroll providers and staff referred for study inclusion from all participating study clinics; not just NYULH staff exclusively.

Patients

1. Adults 18+ years
2. Patients with communication disabilities seen at least once at participating study clinics during the 21-month study period.
3. Patients who self-identify as proficient in English communication as defined by English being a preferred language, or self-reported ability to participate in an interview in English without the support of an interpreter.

Exclusion Criteria:

EHR Data Extraction

1. Patients whose records are unavailable due to technical issues.
2. Patients who are not seen at least once at participating study clinics during the 21-month data collection period.
3. Duplicate records (e.g., duplicative EHR records marked for deletion).
4. Patients who have opted-out of research participation.

Clinic Leadership, Providers & Clinic Staff Interviews and Focus Groups

1. Being <18 years old
2. Not an employed member of a participating study clinic or potential end user of the study implementation strategy.

Patient Interviews

1. Being <18 years old
2. Patients without communication disabilities.
3. Patients with communication disabilities seen outside of participating study clinics.
4. Patients who are unable to provide consent for themselves.
5. Patients who report not being proficient in English communication or self-reported inability to participate in an interview in English without the support of an interpreter.

The de-identified participant data from the final research dataset will be deposited to the digital repository of the Inter-university Consortium for Political and Social Research (ICPSR) to ensure that the research community has long-term access to the data. These files may be accessed directly through the ICPSR website. After agreeing to Terms of Use, users with an ICPSR My Data account and an authorized IP address from a member institution may download the data, and non-members may purchase the files. The research data from this project will be supplied to ICPSR for permanent storage at the end of the project and incrementally; all data not otherwise published by the end of the grant period will be embargoed for one year to allow finalizations of manuscripts and data preparation for sharing. The protocol and statistical analysis plan will be posted on Clinicaltrials.gov only as required by federal regulation or supporting awards and agreements.

The research data from this project will be supplied to ICPSR for permanent storage at the end of the project and incrementally; all data not otherwise published by the end of the grant period will be embargoed for one year to allow finalizations of manuscripts and data preparation for sharing.

Users with an ICPSR My Data account and an authorized IP address from a member institution may download the data, and non-members may purchase the files.