Redesigning the Medical Examination Table; Environmental Factors and Inequitable Health Outcomes for Patients with Physical Disabilities.

Cobb, Sarah, School of Engineering and Applied Science, University of Virginia
Morikawa, Masahiro, UPG-MD-FMED Family Medicine, University of Virginia
Baritaud, Catherine, EN-Engineering and Society, University of Virginia

Persons with physical disabilities receive a drastically lower standard of medical care, leading to rises in missed or incorrect diagnoses causing delays in timely implementation of life-saving treatments. This state-of-the-art technical project aims to redesign the medical examination table to make physical examinations more physically and fiscally accessible for persons with physical disabilities (PWPDs). In addition to physical barriers, environmental factors such as biases, socioeconomic statuses, and interpersonal relationships and attitudes work against PWPDs and lower the standard of medical care received. This research frames the medical policy and decision-making process using both Actor-Network Theory (ANT) to illustrate the influence of environmental factors on discriminatory medical policy and the Advocacy Coalition Framework (ACF) to identify disability advocacy as the most influential factor in creating a more equitable healthcare landscape. The design research on physical barriers and tightly coupled sociotechnical research on the influence of environmental factors offers a comprehensive insight into how to increase the standard of medical care received by PWPDs, creating a more equitable healthcare landscape.
The technical report outlines the development of a medical examination table to improve the fiscal and physical accessibility of quality medical care for persons with physical disabilities. This table addresses the lack of safe transfer height for PWPDs that leads to increased risk of injury or lack of physical examinations for non-ambulatory patients. The lack of accessible diagnostic equipment perpetuates real and potentially life-altering medical consequences for an already at-risk patient population.
This research, relying heavily on prior studies done in the medical accessibility space, has led to the creation of a fully realized medical examination table model. An iterative design process was employed in conjunction with design selection matrices to ensure design specifications such as height, weight, and adjustability were optimized. The finalized design was transformed into a functional 3D animated computer model to illustrate its utility within a medical provider site. Additionally, materials and cost analysis based upon current literature and other competitively priced tables informs future large-scale manufacturing methods and predicted final cost.
The sociotechnical portion of this research identifies and aims to combat environmental factors present within the healthcare system leading to lower standards of care for PWPDs. Unlike physical barriers which are concrete, visible characteristics of a healthcare provider site, environmental factors categorize the unseen social or demographic barriers that influence the healthcare industry. This research postulates that these environmental factors pose a strong and negative influence on the medical policy and decision-making process, leading to discriminatory healthcare policy. Understanding disability perception in the United States acted as foundational research to then inform the application of Actor-Network Theory (ANT) and the Advocacy Coalition Framework (ACF).
The medical and social models of disability have both been identified as shortcomings within modern national disability perception. By using ANT, the expertise that lies with PWPDs is illustrated with the inclusion of environmental factors within the medical policy and decision-making process. Furthermore, the ACF, developed to address complex policy problems in which there are substantial goal disputes involving several actors from multiple levels of government, illustrates the importance of collective policy beliefs while emphasizing that evidence-based advocacy for equitable disability healthcare has the propensity to affect true political change. This political change not only has the potential to further disseminate disability-inclusive sentiments within the political and social spheres, but also to create a more equitable healthcare landscape through enforceable political action.
Equitable standards of care remain a largely unmet problem in the current American healthcare system. By addressing both physical barriers, by offering a more physically and fiscally accessible medical examination table, and environmental factors, by recommending reform through understanding bias and promoting disability advocacy, the technical research and tightly coupled sociotechnical research aim to combat discriminatory healthcare practices in the United States.

BS (Bachelor of Science)
Actor-Network Theory, Equitable Medical Care, Disability Advocacy

School of Engineering and Applied Science
Bachelor of Science in Biomedical Engineering
Technical Advisor: Masahiro Morikawa, M.D.
STS Advisor: Catherine Baritaud
Technical Team Members: Clara Bosworth, Victoria Harvey, Lauren Louw

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