Insights From the Disabled Advanced Medical Assistance Project

IMPORTANCE: Equitable access to health care for persons with disabilities is not always guaranteed, despite the internationally recognized right to health care. Architectural, organizational, and cultural barriers, along with a lack of specialized skills among health care professionals, limit access to care, leading to poorer health outcomes compared with the general population. This Special Communication presents the Disabled Advanced Medical Assistance (DAMA) model, an innovative approach to hospital care for people with disabilities, designed to provide personalized health care pathways and reduce health disparities.

OBSERVATIONS: The DAMA model was developed at San Paolo Hospital-Polo Universitario in Milan and is based on the all at once, all in one place principle, which consolidates medical examinations and treatments into a single hospital visit, reducing repeated hospitalizations and emergency department visits. Currently, more than 43 centers in Italy have adopted this model. Data from the DAMA centers show its ability to apply the reasonable accommodation principle in hospital, its adaptability to different hospital settings, and substantial reduction in emergency department and unplanned hospital admissions. DAMA focuses on a multidisciplinary assessment of patient needs, active involvement of caregivers and specialists, advanced planning of procedures, and the use of procedural sedation to avoid physical restraints.

CONCLUSIONS: The DAMA model represents a notable step toward a more inclusive and equitable health care system for persons with disabilities. Its effectiveness is demonstrated by the decrease in emergency visits and increased patient and caregiver satisfaction. To ensure broader implementation, national and international standards must be established, specialized training for health care professionals should be promoted, and DAMA should be integrated into health policies. The creation of a European DAMA network could further strengthen the right to health care for persons with disabilities by fostering research and the development of more effective care strategies. The DAMA model may facilitate making the reasonable accommodations necessary to guarantee the right to health care of persons with disabilities, as enshrined in the Chapter of Rights of Persons with Disability Hospital and in Article 25 of the United Nations Convention on the Rights of Persons with Disabilities.