1
|
Kim W, Donise KR, Brown KA, Cancilliere MK, Chen ES. Identifying and Characterizing the Transgender and Nonbinary Population Presenting to Pediatric Psychiatry Emergency Services. AMIA JOINT SUMMITS ON TRANSLATIONAL SCIENCE PROCEEDINGS. AMIA JOINT SUMMITS ON TRANSLATIONAL SCIENCE 2024; 2024:565-574. [PMID: 38827092 PMCID: PMC11141824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 06/04/2024]
Abstract
Transgender and nonbinary (TGNB) individuals have an increased risk of certain mental health outcomes, such as depression and suicide attempts. This population skews younger in the United States and prior studies have not included TGNB patients for the entire pediatric age range in an emergency department (ED) setting. The present study aimed to examine gender identity documentation in the electronic health record and then use that information to identify and further characterize the pediatric TGNB population presenting to a psychiatric emergency service. Preliminary findings include a greater percentage of TGNB patients compared to non-TGNB individuals who had repeat visits to the ED for high acuity psychiatric concerns. A larger portion of TGNB patients also had at least one evaluation that included suicidal ideation. These results call for increased attention on the quality of mental healthcare for TGNB youth both inside and outside of the ED.
Collapse
Affiliation(s)
- Wyatt Kim
- The Warren Alpert Medical School of Brown University, Providence, RI
| | - Kathleen R Donise
- Department of Psychiatry and Human Behavior at The Warren Alpert Medical School, Brown University, Providence, RI
- Rhode Island Hospital, Providence, RI
- Emma Pendleton Bradley Hospital, East Providence, RI
| | | | - Mary Kathryn Cancilliere
- Department of Psychiatry and Human Behavior at The Warren Alpert Medical School, Brown University, Providence, RI
- Rhode Island Hospital, Providence, RI
| | - Elizabeth S Chen
- Center for Biomedical Informatics, Brown University, Providence, RI
| |
Collapse
|
2
|
Rosenfeld D, Ramirez-Valles J. Beyond identity and generations: bringing life course theory to studies of older gay men. FRONTIERS IN SOCIOLOGY 2024; 9:1393607. [PMID: 38813397 PMCID: PMC11134570 DOI: 10.3389/fsoc.2024.1393607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Accepted: 04/22/2024] [Indexed: 05/31/2024]
Abstract
The last century's numerous, rapid social changes affecting gay men make studies of gay male aging a ripe topic for life course theory, which views later life as the product of historical grounded interchanges between individual lives, social change, and structural contexts. That identifying as gay can occur at any point in the life course widens some life course theorists' primary focus on early-life events to include those occurring throughout the life course. Yet most historically-attentive research on older gay men focuses on generations and identity development rather than on cohorts - groups who entered a system or context at the same time - or on the cumulative, concrete outcomes of encountering social change at a particular point in the life course. This article argues for gay male aging studies' use of life course theory, specifically, its focus on cohort membership's implications for later life, including cumulative disadvantage, in addition to more generationally-focused investigations. After briefly reviewing scholarship on older gay men, we introduce the life course approach and its critique by queer gerontologists for adopting a heteronormative view of the LGBT life course and eliding its distinctive contours. With particular attention to later-life concrete outcomes rather than identity formation, we explore key historical events in gay men's lives that have produced (in the case of the AIDS epidemic) or could produce (for example, the Marriage Equality Act, the Don't Ask, Don't Tell policy) distinctive gay male cohorts. We then consider intra-cohort variation within gay male cohorts before exploring some the barriers to investigating cohorts and cohort effects among older gay men.
Collapse
Affiliation(s)
- Dana Rosenfeld
- College of Liberal Arts and Sciences, University of Westminster, London, United Kingdom
| | - Jesus Ramirez-Valles
- School of Medicine, Univeristy of California San Francisco, San Francisco, CA, United States
| |
Collapse
|
3
|
Pohl SA, Nelson BA, Patwary TR, Amanuel S, Benz EJ, Lathan CS. Evolution of community outreach and engagement at National Cancer Institute-Designated Cancer Centers, an evolving journey. CA Cancer J Clin 2024. [PMID: 38703384 DOI: 10.3322/caac.21841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Revised: 03/26/2024] [Accepted: 04/09/2024] [Indexed: 05/06/2024] Open
Abstract
Cancer mortality rates have declined during the last 28 years, but that process is not equitably shared. Disparities in cancer outcomes by race, ethnicity, socioeconomic status, sexual orientation and gender identity, and geographic location persist across the cancer care continuum. Consequently, community outreach and engagement (COE) efforts within National Cancer Institute-Designated Cancer Center (NCI-DCC) catchment areas have intensified during the last 10 years as has the emphasis on COE and catchment areas in NCI's Cancer Center Support Grant applications. This review article attempts to provide a historic perspective of COE within NCI-DCCs. Improving COE has long been an important initiative for the NCI, but it was not until 2012 and 2016 that NCI-DCCs were required to define their catchment areas rigorously and to provide specific descriptions of COE interventions, respectively. NCI-DCCs had previously lacked adequate focus on the inclusion of historically marginalized patients in cancer innovation efforts. Integrating COE efforts throughout the research and operational aspects of the cancer centers, at both the patient and community levels, will expand the footprint of COE efforts within NCI-DCCs. Achieving this change requires sustained commitment by the centers to adjust their activities and improve access and outcomes for historically marginalized communities.
Collapse
Affiliation(s)
- Sarah A Pohl
- Division of Population Sciences, Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Barry A Nelson
- Dana-Farber/Harvard Cancer Center Faith Based Cancer Disparities Network, Boston, Massachusetts, USA
| | - Tanjeena R Patwary
- Division of Population Sciences, Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Salina Amanuel
- Columbia University Mailman School of Public Health, New York, New York, USA
| | - Edward J Benz
- Dana-Farber Cancer Center, Dana-Farber/Harvard Cancer Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Christopher S Lathan
- Division of Population Sciences, Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| |
Collapse
|
4
|
Byer L, Orozco-Poore C, Rosendale N. Limitations and Future Directions in Sex, Sexuality, and Gender Diverse Research in Neurology. Ann Neurol 2024; 95:421-431. [PMID: 38112171 DOI: 10.1002/ana.26863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 10/16/2023] [Accepted: 12/09/2023] [Indexed: 12/20/2023]
Abstract
Sex, sexuality, and gender diversity is understudied and underserved in neurology. Neurology research inclusive of LGBTQIA+ (lesbian, gay, bisexual, transgender, queer, intersex, asexual) people is limited. Existing research struggles with a paucity of neurology studies collecting sex, sexuality, and gender diverse (SSGD) data, conflation of sex and gender, lack of precision in measures, neglect of younger and older populations, nebulous benefit to community, and absent intersectionality. Future directions in SSGD neurology research include precise and community-based measurements, respect for LGBTQIA+ colleagues, and the application of minority stress models. All patients stand to benefit from research that elucidates how SSGD variables influence neurological health. ANN NEUROL 2024;95:421-431.
Collapse
Affiliation(s)
- Lennox Byer
- Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, USA
- Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
| | - Casey Orozco-Poore
- Department of Child Neurology, University of California, Los Angeles, Los Angeles, CA, USA
| | - Nicole Rosendale
- Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, USA
- Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
| |
Collapse
|
5
|
Deb B, Porter K, van Cleeff A, Reardon LC, Cook S. Emphasizing Sexual Orientation and Gender Identity Data Capture for Improved Cardiovascular Care of the LGBTQ+ Population. JAMA Cardiol 2024; 9:295-302. [PMID: 38265768 DOI: 10.1001/jamacardio.2023.5267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2024]
Abstract
Importance The rising self-identifying lesbian, gay, bisexual, transgender, and queer (LGBTQ+) population makes understanding the unique health care needs of sexual and gender minoritized patients an urgent one. The interaction between minority stress and cardiovascular disease has been well described among underrepresented minoritized populations. The underrepresentation of minoritized populations in clinical research is partly responsible for worse cardiovascular outcomes in these populations. The absence of sexual orientation and gender identity and expression (SOGIE) data makes it difficult to understand the cardiovascular health of LGBTQ+ adults, thereby widening health care disparities in this population. Advancing cardiovascular health equity for LGBTQ+ patients must begin with careful and accurate SOGIE data collection. Observations Current SOGIE data capture remains inadequate despite federal mandates. Challenges in data collection include political and regulatory discrimination, patient/practitioner hesitancy, lack of supportive guidance on SOGIE data collection, improper terminology, regulatory inertia, and inadequate and often incorrect integration of SOGIE data into electronic health records (EHRs). Additional challenges include grouping participants as "others" for statistical significance. The inclusion of SOGIE data has demonstrated an impact in other fields like cancer survivorship and surgery. The same needs to be done for cardiology. Conclusions and Relevance Potential solutions for improving much-needed SOGIE data collection include (1) implementing LGBTQ+ inclusive policies, (2) integrating SOGIE data into the EHR, (3) educating health care professionals on the relevance of SOGIE to patient-centered care, and (4) creating a diverse cardiovascular workforce. These steps can substantially enhance the ability to collect SOGIE data to address LGBTQ+ cardiovascular health care disparities.
Collapse
Affiliation(s)
- Brototo Deb
- Department of Medicine, Georgetown University-WHC, Washington, DC
| | - Kadijah Porter
- Department of Medicine, University of Miami/Jackson Memorial Hospital, Miami, Florida
| | - Ashlan van Cleeff
- Sanger Heart & Vascular Institute, Atrium Health, Charlotte, North Carolina
| | - Leigh C Reardon
- Division of Cardiology, Department of Medicine, Ahmanson/UCLA Adult Congenital Heart Disease Center and UCLA Children's Heart Center, UCLA, Los Angeles, California
| | - Stephen Cook
- Indiana Heart Physicians, Franciscan Physician Network, Indianapolis, Indiana
| |
Collapse
|
6
|
Yang X, Olatosi B, Weissman S, Li X, Zhang J. Sexual orientation and gender identity measures and viral suppression for people living with HIV: a protocol for a population-based cohort study. BMJ Open 2024; 14:e076997. [PMID: 38326246 PMCID: PMC10860091 DOI: 10.1136/bmjopen-2023-076997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 11/30/2023] [Indexed: 02/09/2024] Open
Abstract
INTRODUCTION The measure of sexual orientation and gender identity (SOGI) data in electronic health records (EHR) has been critical for addressing health disparities and inequalities, especially for HIV care. Given that gender and sexual minorities (eg, transgender, men who have sex with men and intersex) are key groups in people living with HIV (PLWH), SOGI data can facilitate a more accurate understanding about the HIV outcomes (eg, viral suppression) among this key group and then lead to tailored therapeutic services. The two-step SOGI collection method as an emerging gender measurement can be used to measure SOGI status in medical settings. Using the statewide cohort of PLWH in South Carolina (SC), this project aims to: (1) integrate statewide PLWH cohort data with their birth certificate data to evaluate SOGI measurements from multiple EHR sources; and (2) examine differences in viral suppression based on SOGI measurements. METHODS AND ANALYSIS Our EHR database includes several HIV data sources with patients' gender information, such as SC Department of Health and Environmental Control Centre (DHEC), Health Sciences South Carolina (HSSC) and Prisma as well as birth certificate data to retrieve the sex at birth. The SC Enhanced HIV/AIDS Reporting System (e-HARS) from DHEC will provide longitudinal viral load information to define a variety of viral suppression status. Datasources like the SC office of Revenue and Fiscal Affairs (RFA) will extract longitudinal EHR clinical data of all PLWH in SC from multiple health systems; obtain data from other state agencies and link the patient-level data with county-level data from multiple publicly available data sources. ETHICS AND DISSEMINATION The study was approved by the Institutional Review Board at the University of South Carolina (Pro00129906) as a Non-Human Subject study. The study's findings will be published in peer-reviewed journals and disseminated at national and international conferences and through social media.
Collapse
Affiliation(s)
- Xueying Yang
- Health Promotion Education and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
| | - Bankole Olatosi
- Health Services, Policy and Management, University of South Carolina Arnold School of Public Health, Columbia, South Carolina, USA
| | - Sharon Weissman
- Internal Medicine, School of Medicine, University of South Carolina, Columbia, SC, USA
| | - Xiaoming Li
- Health Promotion Education and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
| | - Jiajia Zhang
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
| |
Collapse
|
7
|
Keuroghlian AS. Cisgender Privilege in Public Health Research. Am J Public Health 2024; 114:142-143. [PMID: 38335497 PMCID: PMC10862193 DOI: 10.2105/ajph.2023.307542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2024]
Affiliation(s)
- Alex S Keuroghlian
- The author is with Harvard Medical School, Boston, MA; The Fenway Institute, Fenway Health, Boston; and the Department of Psychiatry, Massachusetts General Hospital, Boston
| |
Collapse
|
8
|
Mayer KH, Peretti M, McBurnie MA, King D, Smith NX, Crawford P, Loo S, Sigal M, Gillespie S, Davis JA, Cahill S, Grasso C, Keuroghlian AS. Training Health Center Staff in the Provision of Culturally Responsive Care for Sexual and Gender Minority Patients: Results of a Randomized Controlled Trial. LGBT Health 2024; 11:131-142. [PMID: 38052073 DOI: 10.1089/lgbt.2022.0322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/07/2023] Open
Abstract
Purpose: The study was designed to evaluate whether an educational intervention to train the health center (HC) staff to optimize care for sexual and gender minority (SGM) patients could improve documentation of sexual orientation and gender identity (SOGI) and increase preventive screenings. Methods: Twelve HCs were matched and randomized to either receive a tailored, multicomponent educational intervention or a 1-hour prerecorded webinar. Documentation of SGM status and clinical testing was measured through analysis of data that HCs report annually. Nonparametric statistics were used to assess associations between baseline HC characteristics and outcome measures. Results: The HCs were geographically, racially, and ethnically diverse. In all but one HC, <10% of the patients were identified as SGM. Intervention HCs underwent between 3 and 10 trainings, which were highly acceptable. In 2018, 9 of 12 HCs documented SO and 11 of 12 documented GI for at least 50% of their patients. Five of 6 intervention HCs increased SO documentation by 2020, compared to 3 of 6 control HCs (nonsignificant, NS). Five intervention HCs increased GI documentation, although generally by less than 10%, compared to 2 of the controls (NS). Intervention HCs tended to increase documentation of preventive services more than control HCs, but the changes were NS. Conclusions: An educational intervention designed to train the HC staff to provide culturally responsive services for SGM patients was found to be acceptable, with favorable, but nonsignificant changes. Further refinement of the intervention using a larger sample of HCs might demonstrate the effectiveness of this approach. Clinical trial registration #: NCT03554785.
Collapse
Affiliation(s)
- Kenneth H Mayer
- The Fenway Institute, Fenway Health, Boston, Massachusetts, USA
- Department of Medicine, Harvard Medical School/Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Matteo Peretti
- The Fenway Institute, Fenway Health, Boston, Massachusetts, USA
| | - Mary Ann McBurnie
- Science Program Department, Kaiser Permanente Center for Health Research, Portland, Oregon, USA
| | - Dana King
- The Fenway Institute, Fenway Health, Boston, Massachusetts, USA
| | - Ning X Smith
- Science Program Department, Kaiser Permanente Center for Health Research, Portland, Oregon, USA
| | - Phillip Crawford
- Research Data Analytics Center, Kaiser Permanente Center for Health Research, Portland, Oregon, USA
| | - Stephanie Loo
- The Fenway Institute, Fenway Health, Boston, Massachusetts, USA
- Department of Health Law, Policy, and Management, School of Public Health, Boston University, Boston, Massachusetts, USA
| | - Maksim Sigal
- The Fenway Institute, Fenway Health, Boston, Massachusetts, USA
| | - Suzanne Gillespie
- Research Data Analytics Center, Kaiser Permanente Center for Health Research, Portland, Oregon, USA
| | - John A Davis
- Department of Medicine, University of California at San Francisco, San Francisco, California, USA
| | - Sean Cahill
- The Fenway Institute, Fenway Health, Boston, Massachusetts, USA
| | - Chris Grasso
- The Fenway Institute, Fenway Health, Boston, Massachusetts, USA
| | - Alex S Keuroghlian
- The Fenway Institute, Fenway Health, Boston, Massachusetts, USA
- Department of Psychiatry, Harvard Medical School/Massachusetts General Hospital, Boston, Massachusetts, USA
| |
Collapse
|
9
|
Li Y, He X, Wheldon C, Wu Y, Prosperi M, Shenkman EA, Jaffee MS, Guo J, Wang F, Guo Y, Bian J. A Computable Phenotype for the Identification of Sexual and Gender Minorities in Electronic Health Records. AMIA ... ANNUAL SYMPOSIUM PROCEEDINGS. AMIA SYMPOSIUM 2024; 2023:1057-1066. [PMID: 38222414 PMCID: PMC10785915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 01/16/2024]
Abstract
Sexual gender minorities, including lesbian, gay, and bisexual (LGB) individuals face unique challenges due to discrimination, stigma, and marginalization, which negatively impact their well-being. Electronic health record (EHR) systems present an opportunity for LGB research, but accurately identifying LGB individuals in EHRs is challenging. Our study developed and validated a rule-based computable phenotype (CP) to identify LGB individuals and their subgroups using both structured data and unstructured clinical narratives from a large integrated health system. Validating against a sample of 537 chart-reviewed patients, our three best performing CP algorithms balancing different performance metrics, each achieved sensitivity of 1.000, PPV of 0.982, and F1-score of 0.875 in identifying LGB individuals, respectively. Applying the three best-performing CPs, our study also found that the LGB population is younger and experiences a disproportionate burden of adverse health outcomes, particularly mental health distress.
Collapse
Affiliation(s)
- Yongqiu Li
- University of Florida, Gainesville, Florida, USA
| | - Xing He
- University of Florida, Gainesville, Florida, USA
| | | | - Yonghui Wu
- University of Florida, Gainesville, Florida, USA
| | | | | | | | | | - Fei Wang
- Weill Cornell Medicine, New York City, New York, USA
| | - Yi Guo
- University of Florida, Gainesville, Florida, USA
| | - Jiang Bian
- University of Florida, Gainesville, Florida, USA
| |
Collapse
|
10
|
Hodan R, Rodgers-Fouche L, Chittenden A, Dominguez-Valentin M, Ferriss J, Gima L, Hamnvik OPR, Idos GE, Kline K, Koeller DR, Long JM, McKenna D, Muller C, Thoman M, Wintner A, Bedrick BS. Cancer surveillance for transgender and gender diverse patients with Lynch syndrome: a practice resource of the Collaborative Group of the Americas on Inherited Gastrointestinal Cancer. Fam Cancer 2023; 22:437-448. [PMID: 37341816 DOI: 10.1007/s10689-023-00341-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 05/31/2023] [Indexed: 06/22/2023]
Abstract
Transgender and gender diverse (TGD) populations with hereditary cancer syndromes face unique obstacles to identifying and obtaining appropriate cancer surveillance and risk-reducing procedures. There is a lack of care provider knowledge about TGD health management. Lynch syndrome (LS) is one of the most common hereditary cancer syndromes, affecting an estimated 1 in 279 individuals. There are no clinical guidelines specific for TGD individuals with LS, highlighting a need to improve the quality of care for this population. There is an urgent need for cancer surveillance recommendations for TGD patients. This commentary provides recommendations for cancer surveillance, risk-reducing strategies, and genetic counseling considerations for TGD patients with LS.
Collapse
Affiliation(s)
- Rachel Hodan
- Cancer Genetics, Stanford Health Care and Department of Pediatrics (Genetics), Stanford University School of Medicine, Palo Alto, CA, USA.
| | - Linda Rodgers-Fouche
- Center for Cancer Risk Assessment, Massachusetts General Hospital, Boston, MA, USA
| | - Anu Chittenden
- Division of Cancer Genetics and Prevention, Dana Farber Cancer Institute, Boston, MA, USA
| | - Mev Dominguez-Valentin
- Department of Tumor Biology, Institute of Cancer Research, The Norwegian Radium Hospital, Oslo, Norway
| | - James Ferriss
- Department of Gynecology and Obstetrics, Kelly Gynecologic Oncology Service, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Lauren Gima
- Division of Clinical Cancer Genomics, City of Hope National Medical Center, Duarte, CA, USA
| | - Ole-Petter R Hamnvik
- Center for Transgender Health, Brigham and Women's Hospital, and Harvard Medical School, Boston, MA, USA
| | - Gregory E Idos
- Division of Gastroenterology, City of Hope National Medical Center, Duarte, CA, USA
| | - Kevin Kline
- Department of Family Medicine and Community Health, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Diane R Koeller
- Division of Cancer Genetics and Prevention, Dana Farber Cancer Institute, Boston, MA, USA
| | - Jessica M Long
- Division of Hematology and Oncology, University of Pennsylvania Health System, Philadelphia, PA, USA
| | - Danielle McKenna
- Division of Hematology and Oncology, University of Pennsylvania Health System, Philadelphia, PA, USA
| | - Charles Muller
- Division of Gastroenterology and Hepatology, Northwestern University, Chicago, IL, USA
| | - Maxton Thoman
- Department of Urology, Massachusetts General Hospital, Boston, MA, USA
| | - Anton Wintner
- Department of Urology, Massachusetts General Hospital, Boston, MA, USA
| | - Bronwyn S Bedrick
- Department of Gynecology and Obstetrics, Johns Hopkins School of Medicine, Baltimore, MD, USA
| |
Collapse
|
11
|
Jackson SS, Parker KL. Commentary on New Guidance for Human Papillomavirus-Related Cancer Screening Among Sexual and Gender Minority Populations. J Low Genit Tract Dis 2023; 27:322-323. [PMID: 37729044 DOI: 10.1097/lgt.0000000000000764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/22/2023]
Affiliation(s)
- Sarah S Jackson
- Division of Cancer Epidemiology and Genetics, The National Cancer Institute, Rockville, MD
| | - Karen L Parker
- Sexual and Gender Minority Research Office, The National Institutes of Health, Bethesda, MD
| |
Collapse
|
12
|
May JT, Myers J, Noonan D, McConnell E, Cary MP. A call to action to improve the completeness of older adult sexual and gender minority data in electronic health records. J Am Med Inform Assoc 2023; 30:1725-1729. [PMID: 37414548 PMCID: PMC10531106 DOI: 10.1093/jamia/ocad130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 05/25/2023] [Accepted: 06/28/2023] [Indexed: 07/08/2023] Open
Abstract
Sexual and gender minority (SGM) older adults experience greater health disparities compared to non-SGM older adults. The SGM older adult population is growing rapidly. To address this disparity and gain a better understanding of their unique challenges in healthcare relies on accurate data collection. We conducted a secondary data analysis of 2018-2022 electronic health record data for older adults aged ≥50 years, in 1 large academic health system to determine the source, magnitude, and correlates of missing sexual orientation and gender identity (SOGI) data among hospitalized older adults. Among 153 827 older adults discharged from the hospital, SOGI data missingness was 67.6% for sexual orientation and 63.0% for gender identity. SOGI data are underreported, leading to bias findings when studying health disparities. Without complete SOGI data, healthcare systems will not fully understand the unique needs of SGM individuals and develop tailored interventions and programs to reduce health disparities among these populations.
Collapse
Affiliation(s)
- Jennifer T May
- Duke University, School of Nursing, Durham, North Carolina, USA
| | - John Myers
- Duke University, School of Nursing, Durham, North Carolina, USA
| | - Devon Noonan
- Duke University, School of Nursing, Durham, North Carolina, USA
| | | | - Michael P Cary
- Duke University, School of Nursing, Durham, North Carolina, USA
| |
Collapse
|
13
|
Kapadia F. Data Democratization for Health Equity: A Public Health of Consequence, August 2023. Am J Public Health 2023; 113:839-840. [PMID: 37406266 PMCID: PMC10323841 DOI: 10.2105/ajph.2023.307350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/21/2023] [Indexed: 07/07/2023]
Affiliation(s)
- Farzana Kapadia
- Farzana Kapadia is the deputy editor of AJPH and is an associate professor of epidemiology at the School of Global Public Health, New York University, New York
| |
Collapse
|
14
|
Streed CG, King D, Grasso C, Reisner SL, Mayer KH, Jasuja GK, Poteat T, Mukherjee M, Shapira-Daniels A, Cabral H, Tangpricha V, Paasche-Orlow MK, Benjamin EJ. Validation of an administrative algorithm for transgender and gender diverse persons against self-report data in electronic health records. J Am Med Inform Assoc 2023; 30:1047-1055. [PMID: 36921287 PMCID: PMC10198536 DOI: 10.1093/jamia/ocad039] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 02/19/2023] [Accepted: 02/25/2023] [Indexed: 03/17/2023] Open
Abstract
OBJECTIVE To adapt and validate an algorithm to ascertain transgender and gender diverse (TGD) patients within electronic health record (EHR) data. METHODS Using a previously unvalidated algorithm of identifying TGD persons within administrative claims data in a multistep, hierarchical process, we validated this algorithm in an EHR data set with self-reported gender identity. RESULTS Within an EHR data set of 52 746 adults with self-reported gender identity (gold standard) a previously unvalidated algorithm to identify TGD persons via TGD-related diagnosis and procedure codes, and gender-affirming hormone therapy prescription data had a sensitivity of 87.3% (95% confidence interval [CI] 86.4-88.2), specificity of 98.7% (95% CI 98.6-98.8), positive predictive value (PPV) of 88.7% (95% CI 87.9-89.4), and negative predictive value (NPV) of 98.5% (95% CI 98.4-98.6). The area under the curve (AUC) was 0.930 (95% CI 0.925-0.935). Steps to further categorize patients as presumably TGD men versus women based on prescription data performed well: sensitivity of 97.6%, specificity of 92.7%, PPV of 93.2%, and NPV of 97.4%. The AUC was 0.95 (95% CI 0.94-0.96). CONCLUSIONS In the absence of self-reported gender identity data, an algorithm to identify TGD patients in administrative data using TGD-related diagnosis and procedure codes, and gender-affirming hormone prescriptions performs well.
Collapse
Affiliation(s)
- Carl G Streed
- Section of General Internal Medicine, Boston University Chobanian and Avedisian School of Medicine, Boston, Massachusetts, USA
- Center for Transgender Medicine and Surgery, Boston Medical Center, Boston, Massachusetts, USA
- The Fenway Institute, Fenway Health, Boston, Massachusetts, USA
| | - Dana King
- The Fenway Institute, Fenway Health, Boston, Massachusetts, USA
| | - Chris Grasso
- The Fenway Institute, Fenway Health, Boston, Massachusetts, USA
| | - Sari L Reisner
- The Fenway Institute, Fenway Health, Boston, Massachusetts, USA
- Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Kenneth H Mayer
- The Fenway Institute, Fenway Health, Boston, Massachusetts, USA
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Guneet K Jasuja
- Section of General Internal Medicine, Boston University Chobanian and Avedisian School of Medicine, Boston, Massachusetts, USA
- Center for Healthcare Organization & Implementation Research, VA Bedford Healthcare System, Bedford, Massachusetts, USA
- Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Tonia Poteat
- Department of Social Medicine, University of North Carolina Chapel Hill, Chapel Hill, North Carolina, USA
| | - Monica Mukherjee
- Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | | | - Howard Cabral
- Department of Biostatistics, School of Public Health, Boston University, Boston, Massachusetts, USA
| | - Vin Tangpricha
- Division of Endocrinology, Metabolism & Lipids, Department of Medicine, School of Medicine, Emory University, Atlanta, Georgia, USA
| | | | - Emelia J Benjamin
- Section of Cardiovascular Medicine, Department of Medicine, Boston University School of Medicine and Boston Medical Center, Boston, Massachusetts, USA
- Boston University's and National Heart, Lung, and Blood Institute's Framingham Heart Study, Framingham, Massachusetts, USA
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, USA
| |
Collapse
|
15
|
Lett E, Ivory JM, Roberson ML. Envisioning trans-inclusive and trans-specific cancer care. Nat Rev Clin Oncol 2023; 20:351-352. [PMID: 37046009 DOI: 10.1038/s41571-023-00764-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/14/2023]
Affiliation(s)
- Elle Lett
- Center for Applied Transgender Studies, Chicago, IL, USA
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Joannie M Ivory
- Division of Hematology & Oncology, Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, NC, USA
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Mya L Roberson
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
- Department of Health Policy and Management, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
| |
Collapse
|
16
|
Loo S, Peretti M, Sigal M, Noe B, Grasso C, S Keuroghlian A, H Mayer K. Health Center Leadership Perspectives Regarding Barriers to and Facilitators of Providing Culturally Responsive Care for Sexual and Gender Minority Patients. LGBT Health 2023. [PMID: 36802213 DOI: 10.1089/lgbt.2022.0135] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2023] Open
Abstract
Purpose: This study identified barriers and facilitators associated with providing culturally responsive care for sexual and gender minority (SGM) patients at federally qualified health centers (FQHCs) in the United States, from the perspective of clinical leadership. Methods: Between July and December 2018, 23 semistructured, in-depth qualitative interviews were held with clinical leaders representing six FQHCs residing in rural and urban settings. Stakeholders included Chief Executive Officer, Executive Director, Chief Medical Officer, Medical Director, Clinic Site Director, and Nurse Manager positions. Interview transcripts were analyzed using inductive thematic analysis. Results: Barriers included personnel factors related to lack of training and fear, competing priorities, and environments that focused on treating all patients similarly. Facilitators included established partnerships with external organizations, staff with prior SGM training and knowledge, and active initiatives in clinic settings targeting SGM care. Conclusions: Clinical leadership expressed strong support for evolving their FQHCs into organizations that provide culturally responsive care for their SGM patients. FQHC staff across all levels of clinical care would benefit from regularly occurring training sessions on culturally responsive care for SGM patients. To ensure sustainability, improve staff buy-in, and mitigate the impact of staff turnover, improving culturally competent care for SGM patients should be a shared goal and responsibility for leadership, medical providers, and administrative staff. CTN Registration: NCT03554785.
Collapse
Affiliation(s)
- Stephanie Loo
- The Fenway Institute, Fenway Health, Boston, Massachusetts, USA.,Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Matteo Peretti
- The Fenway Institute, Fenway Health, Boston, Massachusetts, USA
| | - Maksim Sigal
- The Fenway Institute, Fenway Health, Boston, Massachusetts, USA
| | - Bridget Noe
- The Fenway Institute, Fenway Health, Boston, Massachusetts, USA
| | - Chris Grasso
- The Fenway Institute, Fenway Health, Boston, Massachusetts, USA
| | - Alex S Keuroghlian
- The Fenway Institute, Fenway Health, Boston, Massachusetts, USA.,Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
| | - Kenneth H Mayer
- The Fenway Institute, Fenway Health, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA.,Infectious Disease Division, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| |
Collapse
|
17
|
Mayer KH, Peretti M, McBurnie MA, King D, Smith NX, Crawford P, Loo S, Sigal M, Gillespie S, Cahill S, Keuroghlian AS, Grasso C. Wide Variability in Documentation of Sexual Orientation, Gender Identity, and Preventive Health Screenings in a Diverse Sample of U.S. Community Health Centers. LGBT Health 2022; 9:571-581. [PMID: 35772015 DOI: 10.1089/lgbt.2021.0362] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Purpose: This study was conducted to characterize documentation of sexual orientation and gender identity (SOGI) and provision of screening and preventive services in a diverse sample of community health centers (CHCs). Methods: Twelve CHCs provided data submitted to the Health Resources and Services Administration (HRSA) in 2018 from their Uniform Data System (UDS) reports. Prevalence of SOGI documentation, screenings, and preventive services were calculated. Sociodemographic correlates of documentation were analyzed using Fisher's exact test and Wilcoxon rank sum/Mann-Whitney U test. Results: Patient data recording sexual orientation (SO) were missing in 2%-93% of UDS reports from the 12 CHCs, and gender identity (GI) data were missing from 0% to 96% of UDS reports. CHCs were most likely to report body mass index and tobacco screening and least likely to report hepatitis A or B vaccination, independent of SO or GI. Transgender females were less likely to have mammography documented than cisgender females. Transgender males were less likely to have anal Pap tests, be vaccinated for hepatitis B, or be referred for risky alcohol use compared to cisgender males. Patients who identified as "another gender" were less likely to be referred for risky alcohol use, undergo mammography or anal Pap testing, or receive hepatitis A vaccination than cisgender people. Individuals who did not disclose their GI were less likely to be vaccinated for hepatitis A or B than cisgender people. Conclusion: SOGI status was often not documented by a diverse array of CHCs. However, when SOGI status was documented, we saw evidence of disparities in preventive interventions and referrals, particularly for transgender patients. Clinical trial registration number: NCT03554785.
Collapse
Affiliation(s)
- Kenneth H Mayer
- The Fenway Institute, Fenway Health, Boston, Massachusetts, USA
| | - Matteo Peretti
- The Fenway Institute, Fenway Health, Boston, Massachusetts, USA
| | - Mary Ann McBurnie
- Science Program Department, Kaiser Permanente Center for Health Research, Portland, Oregon, USA
| | - Dana King
- The Fenway Institute, Fenway Health, Boston, Massachusetts, USA
| | - Ning X Smith
- Science Program Department, Kaiser Permanente Center for Health Research, Portland, Oregon, USA
| | - Phil Crawford
- Research Data Analytics Center, Kaiser Permanente Center for Health Research, Portland, Oregon, USA
| | - Stephanie Loo
- The Fenway Institute, Fenway Health, Boston, Massachusetts, USA
| | - Maksim Sigal
- The Fenway Institute, Fenway Health, Boston, Massachusetts, USA
| | - Suzanne Gillespie
- Research Data Analytics Center, Kaiser Permanente Center for Health Research, Portland, Oregon, USA
| | - Sean Cahill
- The Fenway Institute, Fenway Health, Boston, Massachusetts, USA
| | | | - Chris Grasso
- The Fenway Institute, Fenway Health, Boston, Massachusetts, USA
| |
Collapse
|
18
|
Valente PK, Paine EA, Mellman W, Rael CT, MacCrate C, Bockting WO. Positive patient-provider relationships among transgender and nonbinary individuals in New York City. INTERNATIONAL JOURNAL OF TRANSGENDER HEALTH 2022; 24:247-262. [PMID: 37114109 PMCID: PMC10128430 DOI: 10.1080/26895269.2022.2136814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/19/2023]
Abstract
Background: Transgender and nonbinary (TGNB) individuals have diverse health needs and may face disproportionate barriers to healthcare, including developing positive patient-provider relationships. While there is mounting evidence of gender-based stigma and discrimination in healthcare, little is known about how TGNB individuals develop positive patient-provider relationships. Aims: To examine TGNB individuals' interactions with healthcare providers and identify main characteristics of positive patient-providers relationships. Methods: We conducted semi-structured interviews with a purposive sample of 13 TGNB individuals in New York, NY. Interviews were transcribed verbatim and analyzed inductively for themes related to characteristics of positive and trusting relationships with healthcare providers. Results: Participants' mean age was 30 years (IQR = 13 years) and most participants were nonwhite (n = 12, 92%). Receiving peer referrals to specific clinics or providers helped many participants find providers perceived to be competent and created initial grounds for positive patient-provider relationships. Providers with whom participants had positive relationships commonly managed primary care and gender-affirming care and relied on a network of interdisciplinary providers for other specialized care. Providers who were positively evaluated were perceived to possess in-depth clinical knowledge on the issues they were responsible for managing, including gender-affirming interventions, particularly for TGNB patients who perceived themselves to be knowledgeable about TGNB-specific care. Provider and staff cultural competence and a TGNB-affirming clinic environment were also important, particularly early in the patient-provider relationship, and if combined with TGNB clinical competence. Discussion: Provider-focused training and education programs should combine components of TGNB clinical and cultural competence to facilitate development of positive relationships between TGNB patients and providers, thereby improving the health and wellbeing of TGNB people.
Collapse
Affiliation(s)
- Pablo K. Valente
- Division of Gender, Sexuality, and Health, New York State Psychiatric Institute/Columbia Psychiatry, New York, New York, USA
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, Rhode Island, USA
- Department of Allied Health Sciences, University of Connecticut, Waterbury, Connecticut, USA
| | - Emily Allen Paine
- Division of Gender, Sexuality, and Health, New York State Psychiatric Institute/Columbia Psychiatry, New York, New York, USA
| | - William Mellman
- Division of Gender, Sexuality, and Health, New York State Psychiatric Institute/Columbia Psychiatry, New York, New York, USA
| | - Christine T. Rael
- Division of Gender, Sexuality, and Health, New York State Psychiatric Institute/Columbia Psychiatry, New York, New York, USA
- College of Nursing, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Caitlin MacCrate
- Division of Gender, Sexuality, and Health, New York State Psychiatric Institute/Columbia Psychiatry, New York, New York, USA
| | - Walter O. Bockting
- Division of Gender, Sexuality, and Health, New York State Psychiatric Institute/Columbia Psychiatry, New York, New York, USA
| |
Collapse
|
19
|
Townsend M, Clark BA. Universal gender screening: a simple strategy to enhance primary care for transgender and gender diverse people. Fam Pract 2022; 39:985-987. [PMID: 35078244 DOI: 10.1093/fampra/cmab176] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Marria Townsend
- Department of Family Practice, Faculty of Medicine, The University of British Columbia, Vancouver, BC, Canada
| | - Beth A Clark
- School of Population and Public Health, Faculty of Medicine, The University of British Columbia, Vancouver, BC, Canada
| |
Collapse
|
20
|
Albert K, Delano M. Sex trouble: Sex/gender slippage, sex confusion, and sex obsession in machine learning using electronic health records. PATTERNS (NEW YORK, N.Y.) 2022; 3:100534. [PMID: 36033589 PMCID: PMC9403398 DOI: 10.1016/j.patter.2022.100534] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
False assumptions that sex and gender are binary, static, and concordant are deeply embedded in the medical system. As machine learning researchers use medical data to build tools to solve novel problems, understanding how existing systems represent sex/gender incorrectly is necessary to avoid perpetuating harm. In this perspective, we identify and discuss three factors to consider when working with sex/gender in research: "sex/gender slippage," the frequent substitution of sex and sex-related terms for gender and vice versa; "sex confusion," the fact that any given sex variable holds many different potential meanings; and "sex obsession," the idea that the relevant variable for most inquiries related to sex/gender is sex assigned at birth. We then explore how these phenomena show up in medical machine learning research using electronic health records, with a specific focus on HIV risk prediction. Finally, we offer recommendations about how machine learning researchers can engage more carefully with questions of sex/gender.
Collapse
Affiliation(s)
- Kendra Albert
- Cyberlaw Clinic, Harvard Law School, Cambridge, MA 02138, USA
| | - Maggie Delano
- Engineering Department, Swarthmore College, Swarthmore, PA 19146, USA
| |
Collapse
|
21
|
Goldhammer H, Grasso C, Katz-Wise SL, Thomson K, Gordon AR, Keuroghlian AS. Pediatric sexual orientation and gender identity data collection in the electronic health record. J Am Med Inform Assoc 2022; 29:1303-1309. [PMID: 35396995 PMCID: PMC9196694 DOI: 10.1093/jamia/ocac048] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 03/18/2022] [Accepted: 03/24/2022] [Indexed: 11/14/2022] Open
Abstract
The systematic documentation of sexual orientation and gender identity data in electronic health records can improve patient-centered care and help to identify and address health disparities affecting sexual and gender minority populations. Although there are existing guidelines for sexual orientation and gender identity data among adult patients, there are not yet standard recommendations for pediatric patients. In this article, we discuss methods that pediatric primary care organizations can use to collect and document sexual orientation and gender identity information with children and adolescents in electronic health records. These recommendations take into consideration children's developmental stages, the role of caregivers, and the need to protect the privacy of this information. We also focus on the current limitations of electronic health records in capturing the nuances of sexual and gender minority identities and make suggestions for addressing these limitations.
Collapse
Affiliation(s)
| | - Chris Grasso
- The Fenway Institute, Fenway Health, Boston, Massachusetts, USA
| | - Sabra L Katz-Wise
- Division of Adolescent/Young Adult Medicine, Boston Children’s Hospital, Boston, Massachusetts, USA
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
- Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Katharine Thomson
- Department of Psychiatry, Boston Children’s Hospital, Boston, Massachusetts, USA
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
| | - Allegra R Gordon
- Division of Adolescent/Young Adult Medicine, Boston Children’s Hospital, Boston, Massachusetts, USA
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
- Department of Community Health Sciences, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Alex S Keuroghlian
- The Fenway Institute, Fenway Health, Boston, Massachusetts, USA
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
| |
Collapse
|
22
|
McDowell A, Myong C, Tevis D, Fung V. Sexual Orientation and Gender Identity Data Reporting Among U.S. Health Centers. Am J Prev Med 2022; 62:e325-e332. [PMID: 35232619 PMCID: PMC9843854 DOI: 10.1016/j.amepre.2021.12.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 11/22/2021] [Accepted: 12/09/2021] [Indexed: 01/19/2023]
Abstract
INTRODUCTION Sexual orientation and gender identity data collection is necessary to address health inequities. This study examines sexual orientation and gender identity data reporting among community health centers. METHODS Using the 2016-2019 Uniform Data System for 1,381 community health centers, trends in reporting of sexual orientation and gender identity data were examined. Multivariable logistic regression was used to assess associations between community health center characteristics and whether sexual orientation and gender identity data were available for ≥75% of a community health center's patients in 2019. Data were analyzed in 2021. RESULTS In 2016-2019, the percentage of community health centers with sexual orientation and gender identity data for ≥75% of patients increased from 14.9% to 53.0%. In 2019, community health centers were more likely to have this data for ≥75% of patients if they were in nonmetro counties (OR=1.48, 95% CI=1.04, 2.10 versus metro), were in the South (OR=2.27, 95% CI=1.57, 3.31) or West (OR=1.91, 95% CI=1.27, 2.88 versus the Northeast), and had more patients aged between 18 and 39 years (OR=1.04, 95% CI=1.02, 1.07), between 40 and 64 years (OR=1.04, 95% CI=1.02, 1.06 vs <18 years), or veterans (OR=1.10, 95% CI=1.01, 1.20). This was less likely among community health centers serving 10,000-20,000 patients (OR=0.70, 95% CI=0.52, 0.95) and >20,000 patients (OR=0.44, 95% CI=0.32, 0.61 vs <10,000) and community health centers with more patients of American Indian/Alaskan Native (OR=0.98, 95% CI=0.97, 0.99) or unknown race (OR=0.92, 95% CI=0.86, 0.97 versus White). CONCLUSIONS Collection of sexual orientation and gender identity data by community health centers has increased substantially since 2016, although gaps remain.
Collapse
Affiliation(s)
- Alex McDowell
- Mongan Institute Health Policy Research Center, Massachusetts General Hospital, Boston, Massachusetts; Department of Medicine, Harvard Medical School, Boston, Massachusetts.
| | - Catherine Myong
- Mongan Institute Health Policy Research Center, Massachusetts General Hospital, Boston, Massachusetts; Vagelos College of Physicians & Surgeons, Columbia University Irving Medical Center, New York, New York
| | - Delaney Tevis
- Mongan Institute Health Policy Research Center, Massachusetts General Hospital, Boston, Massachusetts; School of Medicine, University of California San Francisco, San Francisco, California
| | - Vicki Fung
- Mongan Institute Health Policy Research Center, Massachusetts General Hospital, Boston, Massachusetts; Department of Medicine, Harvard Medical School, Boston, Massachusetts
| |
Collapse
|
23
|
Hayek SE, Kassir G, Cherro M, Mourad M, Soueidy M, Zrour C, Khoury B. Mental Health of LGBTQ Individuals Who are Arab or of an Arab Descent: A Systematic Review. JOURNAL OF HOMOSEXUALITY 2022:1-23. [PMID: 35499284 DOI: 10.1080/00918369.2022.2060624] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Lesbian, gay, bisexual, transgender, and queer (LGBTQ) individuals are at a higher risk of mental illness when compared to their heterosexual and cisgender counterparts. Most research emanates from Western countries, with a paucity of studies in the Arab world. We systematically reviewed studies assessing the mental health of LGBTQ individuals who live in the Arab world or are of Arab descent. Of 261 articles, seven were eligible for analysis. Depression was the most common psychiatric disorder. Suicidal ideations and attempts were frequent in trans women. Post-traumatic stress disorder was also common, with the majority of precipitating traumatic events being related to sexual orientation and/or gender identity. Societal and familial stressors in the Arab culture are major contributors to the increased vulnerability of the LGBTQ community to mental health challenges. Further research is of utmost need while taking into consideration the Arab socio-cultural context.
Collapse
Affiliation(s)
- Samer El Hayek
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Jackson Health System, Miami, Florida, USA
| | - Ghida Kassir
- Department of Psychiatry, Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Michele Cherro
- Department of Psychiatry, Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Marc Mourad
- Department of Psychiatry, Hotel-Dieu de France, Saint-Joseph University, Beirut, Lebanon
| | - Marianne Soueidy
- Department of Psychiatry and Clinical Psychology, Saint George Hospital University Medical Center, Balamand School of Medicine, Beirut, Lebanon
| | - Carmen Zrour
- Department of Psychiatry, Faculty of Medical Sciences, Lebanese University, Hadath, Lebanon
| | - Brigitte Khoury
- Department of Psychiatry, Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| |
Collapse
|
24
|
López Castillo H, Blackwell CW, Schrimshaw EW. Paradoxical Obesity and Overweight Disparities Among Sexual Minority Men: A Meta-Analysis. Am J Mens Health 2022; 16:15579883221095387. [PMID: 35485875 PMCID: PMC9067055 DOI: 10.1177/15579883221095387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
This study aims to analyze the prevalence and likelihood of overweight, obesity, and elevated body mass index (BMI) among sexual minority men (i.e., men who have sex with men [MSM], men who have sex with men and women [MSMW], and all sexual minority men), using men who have sex with women (MSW) as the reference group. Studies reporting mean BMIs or prevalence or likelihood of obesity, overweight, or elevated BMI categorized by sexual orientation were included. Data were pooled and analyzed to report mean differences (MDs) of BMIs, prevalence rates, odds ratios (ORs), and their respective 95% confidence intervals (CIs). Forty-three studies were included, with a median of 26,507 participants (median 3.37% sexual minority men). The respective mean overweight, obesity, and elevated BMI prevalence rates among MSM (36%, 23%, and 39%) and MSMW (33%, 27%, and 47%) were lower than those of MSW (44%, 26%, and 55%). This finding was consistent with a significantly lower BMI (MD −1.50 [−1.93, −1.08] kg/m2) and a decreased likelihood of overweight (OR 0.75 [0.64, 0.88]) and obesity (OR 0.84 [0.78, 0.90]). Sexual minority men present with a lower prevalence and likelihood of obesity and overweight than their heterosexual counterparts. The obesity paradox—a sustained catabolic state presenting with lower BMI—is a feasible explanation for this phenomenon, although further research exploring paradoxical cardiovascular findings is granted.
Collapse
Affiliation(s)
- Humberto López Castillo
- Department of Health Sciences, College of Health Professions and Sciences, Academic Health Sciences Center, University of Central Florida, Orlando, FL, USA.,Department of Population Health Sciences, College of Medicine, Academic Health Sciences Center, University of Central Florida, Orlando, FL, USA
| | - Christopher W Blackwell
- Department of Nursing Practice, College of Nursing, Academic Health Sciences Center, University of Central Florida, Orlando, FL, USA
| | - Eric W Schrimshaw
- Department of Population Health Sciences, College of Medicine, Academic Health Sciences Center, University of Central Florida, Orlando, FL, USA
| | -
- Department of Health Sciences, College of Health Professions and Sciences, Academic Health Sciences Center, University of Central Florida, Orlando, FL, USA
| |
Collapse
|
25
|
Cahill S, Miller AS, Keuroghlian AS. Sexual and Gender Minority Health Equity in the Biden Administration. JAMA HEALTH FORUM 2022; 3:e214868. [DOI: 10.1001/jamahealthforum.2021.4868] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Sean Cahill
- Health Policy Research, The Fenway Institute
- Department of Health Sciences, Bouve College of Health Sciences, Northeastern University, Boston, Massachusetts
| | - Amitai S. Miller
- Harvard Medical School
- John D. Stoeckle Center for Primary Care Innovation, Massachusetts General Hospital, Boston
| | - Alex S. Keuroghlian
- The National LGBTQIA+ Health Education Center at The Fenway Institute
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
| |
Collapse
|
26
|
Gagnon KW, Bifulco L, Robinson S, Furness B, Lentine D, Anderson D. Qualitative inquiry into barriers and facilitators to transforming primary care for lesbian, gay, bisexual and transgender people in US federally qualified health centres. BMJ Open 2022; 12:e055884. [PMID: 35177460 PMCID: PMC8860040 DOI: 10.1136/bmjopen-2021-055884] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVES Health systems must rapidly move knowledge into practice to address disparities impacting sexual and gender minority (SGM) patients. This qualitative study explores barriers and facilitators that arose during an initiative to improve care for SGM patients in federally qualified health centres (FQHCs) from the perspectives of FQHC staff. DESIGN Cross-sectional qualitative content analysis, using a general inductive approach, of secondary data from transcripts of intervention events offered to FQHC staff and semistructured interviews with staff and FQHC leadership during the intervention. SETTING 10 FQHCs from nine states in the USA. PARTICIPANTS FQHC quality improvement (QI) and clinical care staff, and leaders at each FQHC. INTERVENTIONS The transforming care for lesbian, gay, bisexual and transgender people QI initiative combined two evidence-based programmes, Learning Collaborative (LC) and Project Extension for Community Healthcare Outcomes (ECHO), to assist primary care health centres in developing capacity to identify SGM patients, monitor their health and care, and improve disparities. PRIMARY AND SECONDARY OUTCOME MEASURES The primary outcome was identification of barriers and facilitators to implementing initiatives to improve care for SGM patients. The secondary outcome was clarification of how intervention participants used Project ECHO sessions versus LC meetings to obtain information that influenced implementation of the initiative at their FQHC. RESULTS Barriers and facilitators mapped to two major themes: 'Clinical' (patients' health, wellness, and available treatment) and Health Systems and Institutional Culture (FQHC operations, and customs and social institutions within the FQHCs and in the external environment). Common 'Clinical' inquiries were for assistance with behavioural health, pre-exposure prophylaxis and transgender hormone therapy. Prevalent facilitators included workflow change and staff training, while adapting electronic health records for data collection, decision support and data extraction was the most prevalent barrier. CONCLUSIONS Project ECHO and LC provided complimentary forums to explore clinical and operational changes needed to improve care for SGM at FQHCs.
Collapse
Affiliation(s)
- Kelly W Gagnon
- Department of Behavioral and Community Health Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Weitzman Institute, Community Health Center Inc, Middletown, Connecticut, USA
- Center for LGBT Health Research, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Lauren Bifulco
- Weitzman Institute, Community Health Center Inc, Middletown, Connecticut, USA
| | - Sarafina Robinson
- Weitzman Institute, Community Health Center Inc, Middletown, Connecticut, USA
| | - Bruce Furness
- Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
- HIV/AIDS, Hepatitis, STD and TB Administration, District of Columbia Department of Health, Washington, District of Columbia, USA
| | - Daniel Lentine
- Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Daren Anderson
- Weitzman Institute, Community Health Center Inc, Middletown, Connecticut, USA
| |
Collapse
|
27
|
Kronk CA, Everhart AR, Ashley F, Thompson HM, Schall TE, Goetz TG, Hiatt L, Derrick Z, Queen R, Ram A, Guthman EM, Danforth OM, Lett E, Potter E, Sun SD, Marshall Z, Karnoski R. Transgender data collection in the electronic health record: Current concepts and issues. J Am Med Inform Assoc 2022; 29:271-284. [PMID: 34486655 PMCID: PMC8757312 DOI: 10.1093/jamia/ocab136] [Citation(s) in RCA: 66] [Impact Index Per Article: 33.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 05/13/2021] [Accepted: 06/18/2021] [Indexed: 11/13/2022] Open
Abstract
There are over 1 million transgender people living in the United States, and 33% report negative experiences with a healthcare provider, many of which are connected to data representation in electronic health records (EHRs). We present recommendations and common pitfalls involving sex- and gender-related data collection in EHRs. Our recommendations leverage the needs of patients, medical providers, and researchers to optimize both individual patient experiences and the efficacy and reproducibility of EHR population-based studies. We also briefly discuss adequate additions to the EHR considering name and pronoun usage. We add the disclaimer that these questions are more complex than commonly assumed. We conclude that collaborations between local transgender and gender-diverse persons and medical providers as well as open inclusion of transgender and gender-diverse individuals on terminology and standards boards is crucial to shifting the paradigm in transgender and gender-diverse health.
Collapse
Affiliation(s)
- Clair A Kronk
- Center for Medical Informatics, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Avery R Everhart
- Population, Health, and Place Program, Spatial Sciences Institute, University of Southern California, Los Angeles, California, USA
- Center for Applied Transgender Studies, Chicago, Illinois, USA
| | - Florence Ashley
- Center for Applied Transgender Studies, Chicago, Illinois, USA
- Faculty of Law and Joint Centre for Bioethics, University of Toronto, Toronto, Ontario, Canada
| | - Hale M Thompson
- Department of Psychiatry and Behavioral Science, Rush University Medical Center, Chicago, Illinois, USA
| | - Theodore E Schall
- Berman Institute of Bioethics, Department of Health Policy and Management, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Teddy G Goetz
- Department of Psychiatry, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Laurel Hiatt
- University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Zackary Derrick
- School of Public Health and Social Policy, University of Victoria, Victoria, British Columbia, Canada
| | - Roz Queen
- Health Information Science, School of Human and Social Development, University of Victoria, Victoria, British Columbia, Canada
| | - A Ram
- Program in Computational Biology and Bioinformatics, Yale University, New Haven, Connecticut, USA
| | - E Mae Guthman
- Center for Applied Transgender Studies, Chicago, Illinois, USA
- Princeton Neuroscience Institute, Princeton University, Princeton, New Jersey, USA
| | - Olivia M Danforth
- Department of Family Medicine, Samaritan Health Services Geary St. Clinic, Albany, Oregon, USA
| | - Elle Lett
- Center for Applied Transgender Studies, Chicago, Illinois, USA
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Emery Potter
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - Simón(e) D Sun
- Center for Applied Transgender Studies, Chicago, Illinois, USA
- Center for Neural Science, New York University, New York, New York, USA
- Department of Neuroscience and Physiology, Neuroscience Institute, NYU Grossman Medical Center, New York, New York, USA
| | - Zack Marshall
- School of Social Work, McGill University, Montreal, Quebec, Canada
| | - Ryan Karnoski
- Center for Applied Transgender Studies, Chicago, Illinois, USA
- School of Social Welfare, University of California, Berkeley, Berkeley, California, USA
| |
Collapse
|
28
|
Fareed N, Swoboda CM, Lawrence J, Griesenbrock T, Huerta T. Co-establishing an infrastructure for routine data collection to address disparities in infant mortality: planning and implementation. BMC Health Serv Res 2022; 22:4. [PMID: 34974826 PMCID: PMC8722266 DOI: 10.1186/s12913-021-07393-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 11/30/2021] [Indexed: 11/20/2022] Open
Abstract
Background Efforts to address infant mortality disparities in Ohio have historically been adversely affected by the lack of consistent data collection and infrastructure across the community-based organizations performing front-line work with expectant mothers, and there is no established template for implementing such systems in the context of diverse technological capacities and varying data collection magnitude among participating organizations. Methods Taking into account both the needs and limitations of participating community-based organizations, we created a data collection infrastructure that was refined by feedback from sponsors and the organizations to serve as both a solution to their existing needs and a template for future efforts in other settings. Results By standardizing the collected data elements across participating organizations, integration on a scale large enough to detect changes in a rare outcome such as infant mortality was made possible. Datasets generated through the use of the established infrastructure were robust enough to be matched with other records, such as Medicaid and birth records, to allow more extensive analysis. Conclusion While a consistent data collection infrastructure across multiple organizations does require buy-in at the organizational level, especially among participants with little to no existing data collection experience, an approach that relies on an understanding of existing barriers, iterative development, and feedback from sponsors and participants can lead to better coordination and sharing of information when addressing health concerns that individual organizations may struggle to quantify alone. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-07393-1.
Collapse
Affiliation(s)
- Naleef Fareed
- CATALYST - The Center for the Advancement of Team Science, Analytics, and Systems Thinking, College of Medicine, The Ohio State University, Institute for Behavioral Medicine Research, 460 Medical Center Drive, Columbus, OH, 43210, USA. .,Department of Biomedical Informatics, College of Medicine, The Ohio State University, Institute for Behavioral Medicine Research, 460 Medical Center Drive, Columbus, OH, 43210, USA.
| | - Christine M Swoboda
- CATALYST - The Center for the Advancement of Team Science, Analytics, and Systems Thinking, College of Medicine, The Ohio State University, Institute for Behavioral Medicine Research, 460 Medical Center Drive, Columbus, OH, 43210, USA.,Department of Family Medicine, College of Medicine, The Ohio State University, Institute for Behavioral Medicine Research, 460 Medical Center Drive,, Columbus, OH, 43210, USA
| | - John Lawrence
- CATALYST - The Center for the Advancement of Team Science, Analytics, and Systems Thinking, College of Medicine, The Ohio State University, Institute for Behavioral Medicine Research, 460 Medical Center Drive, Columbus, OH, 43210, USA
| | - Tyler Griesenbrock
- CATALYST - The Center for the Advancement of Team Science, Analytics, and Systems Thinking, College of Medicine, The Ohio State University, Institute for Behavioral Medicine Research, 460 Medical Center Drive, Columbus, OH, 43210, USA
| | - Timothy Huerta
- CATALYST - The Center for the Advancement of Team Science, Analytics, and Systems Thinking, College of Medicine, The Ohio State University, Institute for Behavioral Medicine Research, 460 Medical Center Drive, Columbus, OH, 43210, USA.,Department of Biomedical Informatics, College of Medicine, The Ohio State University, Institute for Behavioral Medicine Research, 460 Medical Center Drive, Columbus, OH, 43210, USA.,Department of Family Medicine, College of Medicine, The Ohio State University, Institute for Behavioral Medicine Research, 460 Medical Center Drive,, Columbus, OH, 43210, USA
| |
Collapse
|
29
|
Patel RA, Stebbins G, Witek N. Sexual orientation and gender identity documentation at an academic movement disorders neurology clinic. Clin Park Relat Disord 2022; 7:100164. [PMID: 36134251 PMCID: PMC9483721 DOI: 10.1016/j.prdoa.2022.100164] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 09/05/2022] [Indexed: 11/17/2022] Open
|
30
|
Gaither TW, Williams K, Mann C, Weimer A, Ng G, Litwin MS. Initial Clinical Needs Among Transgender and Non-binary Individuals in a Large, Urban Gender Health Program. J Gen Intern Med 2022; 37:110-116. [PMID: 33904031 PMCID: PMC8739414 DOI: 10.1007/s11606-021-06791-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Accepted: 04/01/2021] [Indexed: 01/03/2023]
Abstract
BACKGROUND Transgender and gender-diverse individuals are particularly vulnerable to healthcare discrimination and related health sequelae. OBJECTIVE To demonstrate diversity in demographics and explore variance in needs at the time of intake among patients seeking care at a large, urban gender health program. DESIGN We present summary statistics of patient demographics, medical histories, and gender-affirming care needs stratified by gender identity and sexual orientation. PARTICIPANTS We reviewed all intake interviews with individuals seeking care in our gender health program from 2017 to 2020. MAIN MEASURES Clients reported all the types of care in which they were interested at the time of intake as their "reason for call" (i.e., establish primary care, hormone management, surgical services, fertility services, behavioral health, or other health concerns). KEY RESULTS Of 836 patients analyzed, 350 identified as trans women, 263 as trans men, and 223 as non-binary. The most prevalent sexual identity was straight among trans women (34%) and trans men (38%), whereas most (69%) non-binary individuals identified as pansexual or queer; only 3% of non-binary individuals identified as straight. Over half of patients reported primary care, hormone management, or surgical services as the primary reason for contacting our program. Straight, transgender women were more likely to report surgical services as their primary reason for contacting our program, whereas gay transgender men were more likely to report primary care as their reason. CONCLUSIONS Individuals contacting our gender health program to establish care were diverse in sexual orientation and gender-affirming care needs. Care needs varied with both gender identity and sexual orientation, but primary care, hormone management, and surgical services were high priorities across groups. Providers of gender-affirming care should inquire about sexual orientation and detailed treatment priorities, as trans and gender-diverse populations are not uniform in their treatment needs or goals.
Collapse
Affiliation(s)
- Thomas W Gaither
- Department of Urology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA.
| | - Kristen Williams
- Department of Urology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
| | - Christopher Mann
- Department of Urology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
| | - Amy Weimer
- Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
| | - Gladys Ng
- Department of Urology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
| | - Mark S Litwin
- Department of Urology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA.,Department of Health Policy & Management, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, CA, USA.,School of Nursing, University of California, Los Angeles, Los Angeles, CA, USA
| |
Collapse
|
31
|
Wong WG, Curran P, Koetter P, Hoover T, Roden RC, Martin K. Are pediatric surgery clinics LGBTQ+ inclusive? J Pediatr Surg 2022; 57:104-110. [PMID: 34670677 DOI: 10.1016/j.jpedsurg.2021.09.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 09/08/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE Creating inclusive LGBTQ+ environments is important in the provision of inclusive care. This cross sectional study assessed whether patient intake forms in pediatric surgery departments were LGBTQ+ inclusive (L-I). METHODS North American pediatric surgery departments affiliated with pediatric surgery fellowships or general surgery residencies were contacted to retrieve patient intake forms. Forms were assessed for LGBTQ+ inclusivity using a novel L-I scoring system consisting of 6 criteria: preferred name, pronouns, preferred language, gender identity, sex assigned at birth, and l-I guardianship. Institutions without intake forms were invited to comment on their use of l-I intake questions. RESULTS 59/125 programs responded to our query, 10 of which provided intake forms. Median l-I score was 2/6 points (range 1-4). l-I guardianship was the most common question asked. No intake form asked for pronouns. Of the 49 institutions without forms, 30.5% reported asking l-I questions during initial visits. Narratives from these institutions varied widely. Some institutions supported routine l-I questions while others stated l-I questions were unnecessary, irrelevant, and/or offensive. CONCLUSIONS Few North American pediatric surgery departments consistently ask l-I questions during the intake process. Comments questioning the appropriateness and necessity of l-I questions highlight the need for LGBTQ+ education. LEVEL OF EVIDENCE Level III. TYPE OF STUDY Cross sectional study.
Collapse
Affiliation(s)
- William G Wong
- Department of Pediatric Surgery, PennState Health Milton S. Hershey Medical Center, 500 University Drive, Hershey, PA, USA.
| | - Pierce Curran
- PennState College of Medicine, 500 University Drive, Hershey, PA, USA
| | - Paige Koetter
- PennState College of Medicine, 500 University Drive, Hershey, PA, USA
| | - Travis Hoover
- PennState College of Medicine, 500 University Drive, Hershey, PA, USA
| | - Rosemary Claire Roden
- Division of Adolescent Medicine, Department of Pediatrics, PennState Health Milton S. Hershey Medical Center, 12 Briarcrest Square, Hershey, PA 17033, USA
| | - Kathryn Martin
- Department of Pediatric Surgery, PennState Health Milton S. Hershey Medical Center, 500 University Drive, Hershey, PA, USA
| |
Collapse
|
32
|
Affiliation(s)
- Alex S Keuroghlian
- The Fenway Institute, Fenway Health, Boston, Massachusetts, USA. .,Massachusetts General Hospital, Boston, Massachusetts, USA. .,Harvard Medical School, Boston, Massachusetts, USA.
| |
Collapse
|
33
|
Almazan AN, King D, Grasso C, Cahill S, Lattanner M, Hatzenbuehler ML, Keuroghlian AS. Sexual Orientation and Gender Identity Data Collection at US Health Centers: Impact of City-Level Structural Stigma in 2018. Am J Public Health 2021; 111:2059-2063. [PMID: 34499534 PMCID: PMC8630472 DOI: 10.2105/ajph.2021.306414] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/17/2021] [Indexed: 11/04/2022]
Abstract
Objectives. To examine the relationship between city-level structural stigma pertaining to sexual orientation and gender identity (SOGI) and completeness of patient SOGI data collection at US federally qualified health centers (FQHCs). Methods. We used the Human Rights Campaign's Municipal Equality Index to quantify city-level structural stigma against sexual and gender minority people in 506 US cities across 49 states. We ascertained the completeness of SOGI data collection at FQHCs from the 2018 Uniform Data System, which describes FQHC patient demographics and service utilization. We included FQHCs in cities captured by the structural stigma index in multinomial generalized linear mixed models to examine the relationship between city-level structural stigma and SOGI data completeness. Results. FQHCs in cities with more protective sexual orientation nondiscrimination policies reported more complete patient sexual orientation data (adjusted odds ratio [AOR] = 1.6; 95% confidence interval [CI] = 1.2, 2.1). This association was also found for gender identity nondiscrimination policies and gender identity data collection (AOR = 1.7; 95% CI = 1.3, 2.2). Conclusions. Municipal sexual and gender minority nondiscrimination laws are associated with social and municipal environments that facilitate patient SOGI data collection.(Am J Public Health. 2021;111(11):2059-2063. https://doi.org/10.2105/AJPH.2021.306414).
Collapse
Affiliation(s)
- Anthony N Almazan
- Anthony N. Almazan is with Harvard Medical School, Boston, MA. Dana King, Chris Grasso, Sean Cahill, and Alex S. Keuroghlian are with The Fenway Institute, Fenway Health, Boston. Micah Lattanner and Mark L. Hatzenbuehler are with the Department of Psychology, Harvard University, Boston
| | - Dana King
- Anthony N. Almazan is with Harvard Medical School, Boston, MA. Dana King, Chris Grasso, Sean Cahill, and Alex S. Keuroghlian are with The Fenway Institute, Fenway Health, Boston. Micah Lattanner and Mark L. Hatzenbuehler are with the Department of Psychology, Harvard University, Boston
| | - Chris Grasso
- Anthony N. Almazan is with Harvard Medical School, Boston, MA. Dana King, Chris Grasso, Sean Cahill, and Alex S. Keuroghlian are with The Fenway Institute, Fenway Health, Boston. Micah Lattanner and Mark L. Hatzenbuehler are with the Department of Psychology, Harvard University, Boston
| | - Sean Cahill
- Anthony N. Almazan is with Harvard Medical School, Boston, MA. Dana King, Chris Grasso, Sean Cahill, and Alex S. Keuroghlian are with The Fenway Institute, Fenway Health, Boston. Micah Lattanner and Mark L. Hatzenbuehler are with the Department of Psychology, Harvard University, Boston
| | - Micah Lattanner
- Anthony N. Almazan is with Harvard Medical School, Boston, MA. Dana King, Chris Grasso, Sean Cahill, and Alex S. Keuroghlian are with The Fenway Institute, Fenway Health, Boston. Micah Lattanner and Mark L. Hatzenbuehler are with the Department of Psychology, Harvard University, Boston
| | - Mark L Hatzenbuehler
- Anthony N. Almazan is with Harvard Medical School, Boston, MA. Dana King, Chris Grasso, Sean Cahill, and Alex S. Keuroghlian are with The Fenway Institute, Fenway Health, Boston. Micah Lattanner and Mark L. Hatzenbuehler are with the Department of Psychology, Harvard University, Boston
| | - Alex S Keuroghlian
- Anthony N. Almazan is with Harvard Medical School, Boston, MA. Dana King, Chris Grasso, Sean Cahill, and Alex S. Keuroghlian are with The Fenway Institute, Fenway Health, Boston. Micah Lattanner and Mark L. Hatzenbuehler are with the Department of Psychology, Harvard University, Boston
| |
Collapse
|
34
|
Ciria-Barreiro E, Moreno-Maldonado C, Rivera F, Moreno C. A Comparative Study of Health and Well-being Among Cisgender and Binary and Nonbinary Transgender Adolescents in Spain. LGBT Health 2021; 8:536-544. [PMID: 34648726 DOI: 10.1089/lgbt.2020.0477] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Purpose: The aim of this study was to describe the well-being and mental health of Spanish adolescents by gender identity using a nationally representative sample. Methods: The sample comprised 1212 15-18-year-old adolescents who participated in the 2018 Spanish edition of the international Health Behaviour in School-aged Children study. Of the total sample, 90 were identified as binary transgender adolescents, 213 as nonbinary transgender adolescents, and 909 as cisgender adolescents (selected through a matching process from an original sample of 17,375 cisgender adolescents). Comparisons of frequencies and means (chi-square, t-test, and analysis of variance) were used to analyze self-reported health, life satisfaction, health-related quality of life (HRQOL), psychosomatic complaints, and sense of coherence (SOC). Results: Nonbinary transgender adolescents reported the lowest levels of perceived excellent health (p < 0.001), the highest frequency of psychological complaints (p < 0.001) and physical complaints (p < 0.05), and a lower SOC (p < 0.05) compared with both cisgender and binary transgender adolescents. Likewise, nonbinary transgender adolescents reported lower levels of life satisfaction (p < 0.001) and HRQOL (p < 0.001) than cisgender adolescents. Conclusions: The differences found between binary and nonbinary transgender youth highlight the diversity within the transgender community. Both research and intervention programs should consider the unique experiences within the transgender community to adapt sensitively to their needs.
Collapse
Affiliation(s)
- Esther Ciria-Barreiro
- Department of Developmental and Educational Psychology, Faculty of Psychology, University of Seville, Seville, Spain
| | - Concepción Moreno-Maldonado
- Department of Developmental and Educational Psychology, Faculty of Psychology, University of Seville, Seville, Spain
| | - Francisco Rivera
- Department of Experimental Psychology, Faculty of Psychology, University of Seville, Seville, Spain
| | - Carmen Moreno
- Department of Developmental and Educational Psychology, Faculty of Psychology, University of Seville, Seville, Spain
| |
Collapse
|
35
|
Tan ASL, Potter J. How the Expansion of the U.S. Preventive Services Task Force Lung Cancer Screening Eligibility May Improve Health Equity Among Diverse Sexual and Gender Minority Populations. LGBT Health 2021; 8:503-506. [PMID: 34619037 DOI: 10.1089/lgbt.2021.0188] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
This article discusses the potential implications of addressing lung cancer disparities among diverse sexual and gender minority (SGM) populations based on the recently expanded U.S. Preventive Services Task Force 2021 guidelines on lung cancer screening using low-dose computed tomography to include adults aged 50-80 years who have a 20 pack-year smoking history (one pack-year equals smoking one pack or 20 cigarettes per day for 1 year) and currently smoke or have quit within the past 15 years. Research on lung cancer screening barriers and facilitators and efforts to increase awareness and screening uptake among SGM populations are proposed.
Collapse
Affiliation(s)
- Andy S L Tan
- Annenberg School for Communication and University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Jennifer Potter
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA.,The Fenway Institute, Boston, Massachusetts, USA.,Division of General Internal Medicine, Beth Israel Lahey Health, Boston, Massachusetts, USA
| |
Collapse
|
36
|
McClure RC, Macumber CL, Kronk C, Grasso C, Horn RJ, Queen R, Posnack S, Davison K. Gender harmony: improved standards to support affirmative care of gender-marginalized people through inclusive gender and sex representation. J Am Med Inform Assoc 2021; 29:354-363. [PMID: 34613410 PMCID: PMC8757317 DOI: 10.1093/jamia/ocab196] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 08/04/2021] [Accepted: 09/05/2021] [Indexed: 11/13/2022] Open
Abstract
Objective Accurate representation of clinical sex and gender identity in interoperable clinical
systems is a major challenge for organizations intent on improving outcomes for sex- and
gender-marginalized people. Improved data collection has been hindered by the historical
approach that presumed a single, often binary, datum was sufficient. We describe the
Health Level Seven International (HL7) Gender Harmony logical model that proposes an
improved approach. Materials and Methods The proposed solution was developed via an American National Standards Institute
(ANSI)-certified collaborative balloted process. As an HL7 Informative Document, it is
an HL7 International-balloted consensus on the subject of representing sex and
representing gender in clinical systems based on work of the gender harmony project led
by the HL7 Vocabulary Work Group. Results The Gender Harmony Model is a logical model that provides a standardized approach that
is both backwards-compatible and an improvement to the meaningful capture of gender
identity, recorded sex or recorded gender, a sex for clinical use, the name to use, and
pronouns that are affirmative and inclusive of gender-marginalized people. Conclusion Most clinical systems and current standards in health care do not meaningfully address,
nor do they consistently represent, sex and gender diversity, which has impeded
interoperability and led to suboptimal health care. The Gender Harmony Project was
formed to create more inclusive health information exchange standards to enable a safer,
higher-quality, and embracing healthcare experience. The Gender Harmony Model provides
the informative guidance for standards developers to implement a more thorough technical
design that improves the narrow binary design used in many legacy clinical systems.
Collapse
Affiliation(s)
| | | | - Clair Kronk
- Department of Biomedical Informatics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | | | | | - Roz Queen
- School of Health Information Science, University of Victoria, Victoria, BC, Canada
| | - Steven Posnack
- US Department of Health and Human Services, Office of the National Coordinator for Health IT, Washington, District of Columbia, USA
| | - Kelly Davison
- Canada Health Infoway, Toronto, ON, Canada.,School of Health Information Science, University of Victoria, Victoria, BC, Canada
| |
Collapse
|
37
|
Cruz TM, Paine EA. Capturing patients, missing inequities: Data standardization on sexual orientation and gender identity across unequal clinical contexts. Soc Sci Med 2021; 285:114295. [PMID: 34428618 PMCID: PMC8765327 DOI: 10.1016/j.socscimed.2021.114295] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 07/21/2021] [Accepted: 08/02/2021] [Indexed: 12/30/2022]
Abstract
In effort to address fundamental causes and reduce health disparities, public programs increasingly mandate sites of care to capture patient data on social and behavioral domains within Electronic Health Records (EHRs). Data reporting drawing from EHRs plays an essential role in public management of social problems, and data on social factors are commonly cited as foundational for eliminating health inequities. Yet one major shortcoming of these data-centered initiatives is their limited attention to social context, including the institutional conditions of biomedical stratification and variation of care provision across clinical settings. In this article, we leverage comparative fieldwork to examine provider and system responses to mandated data collection on patient sexual orientation and gender identity (SOGI), highlighting unequal clinical contexts as they appear across a large county safety-net institution and an LGBTQ-oriented health organization. Although point of care data collection is commonly justified for governance in the aggregate (e.g., disparity monitoring), we find standardized data on social domains presents a double-edged sword in clinical settings: formal categories promote visibility where certain issues remain hidden, yet constrain clinical utility in sites with greater knowledge and experience with related topics. We further illustrate how data standardization captures patient identities yet fundamentally misses these unequal contexts, resulting in limited attenuation of inequity despite broad expectations of clinical change. By revealing the often-invisible contexts of care that elude standard measurement, our findings underline the strengths of qualitative social science in accounting for the complex dynamics of enduring social problems. We call for deeper engagement with the unequal contexts of biomedical stratification, especially in light of increasing pressure to quantify the social amidst the rising tide of data-driven care.
Collapse
Affiliation(s)
- Taylor M Cruz
- California State University, Fullerton, Department of Sociology, 2600 Nutwood Avenue, College Park 900, Fullerton, CA 92831, United States.
| | - Emily Allen Paine
- Columbia University and New York State Psychiatric Institute, HIV Center for Clinical and Behavioral Studies, 722 W 168th Street, New York, NY 10032, United States.
| |
Collapse
|
38
|
|
39
|
Loo S, Almazan AN, Vedilago V, Stott B, Reisner SL, Keuroghlian AS. Understanding community member and health care professional perspectives on gender-affirming care-A qualitative study. PLoS One 2021; 16:e0255568. [PMID: 34398877 PMCID: PMC8366980 DOI: 10.1371/journal.pone.0255568] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 07/16/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Transgender and gender diverse (TGD) people experience significant barriers to accessing affirming health services. There is a paucity of literature examining how both community members and health care professionals (HCPs) understand potential causes and solutions for these barriers, particularly in non-urban settings. OBJECTIVE We present the first systematic examination of perspectives from community members and HCPs regarding barriers to and solutions for promoting access to gender-affirming health care. DESIGN Study activities were conducted through the Plan and Act for Transgender Health (PATH) Project, a health needs assessment of TGD people. Community members in the catchment area were recruited to participate in focus group discussions about access to gender-affirming health care and optimal health service delivery models in March-October 2019. HCPs were recruited to participate in focus group discussions or in-depth interviews about experiences working with TGD clients. Data were analyzed using an inductive grounded theory approach. SETTING 25 rural counties in Massachusetts, New York, Connecticut, Vermont, and New Hampshire. PARTICIPANTS Study participants included 61 adult TGD community members and 23 HCPs working in the catchment area. RESULTS Both community members and HCPs spoke of the need for connectedness and linkages among disparate health system components for gender-affirming health care. Participants expressed this priority through calls for systems-level improvements within existing services (e.g., expanded data collection, expanded mental health services, inclusive and affirming health care environments, and TGD staff). They also expressed the need for expanded TGD community outreach and engagement (e.g., incorporation of a patient feedback process, TGD health navigators, and resource mapping). LIMITATIONS Findings specifically reflect the perspectives of community members and HCPs in the rural New England area. Furthermore, the study sample was predominantly White non-Hispanic. CONCLUSION Interventions to achieve accessible gender-affirming health care must address the diverse perspectives and needs of both community members and HCPs.
Collapse
Affiliation(s)
- Stephanie Loo
- The Fenway Institute, Fenway Health, Boston, Massachusetts, United States of America
- Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, Massachusetts, United States of America
| | | | - Virginia Vedilago
- The Fenway Institute, Fenway Health, Boston, Massachusetts, United States of America
| | - Brooke Stott
- The Fenway Institute, Fenway Health, Boston, Massachusetts, United States of America
| | - Sari L. Reisner
- The Fenway Institute, Fenway Health, Boston, Massachusetts, United States of America
- Harvard Medical School, Boston, Massachusetts, United States of America
- Division of Endocrinology, Diabetes, and Hypertension, Brigham and Women’s Hospital, Boston, Massachusetts, United States of America
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Alex S. Keuroghlian
- The Fenway Institute, Fenway Health, Boston, Massachusetts, United States of America
- Harvard Medical School, Boston, Massachusetts, United States of America
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, United States of America
| |
Collapse
|
40
|
Gil RM, Freeman T, Mathew T, Kullar R, Ovalle A, Nguyen D, Kottkamp A, Poon J, Marcelin J, Swartz TH. The LGBTQ+ communities and the COVID-19 pandemic: a call to break the cycle of structural barriers. J Infect Dis 2021; 224:1810-1820. [PMID: 34323998 DOI: 10.1093/infdis/jiab392] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 07/28/2021] [Indexed: 11/12/2022] Open
Abstract
The COVID-19 pandemic has disproportionately impacted LGBTQ+ communities. Many disparities mirror those of the HIV/AIDS epidemic. These health inequities have repeated throughout history due to the structural oppression of LGBTQ+ people. We aim to demonstrate that the familiar patterns of LGBTQ+ health disparities reflect a perpetuating, deeply rooted cycle of injustice imposed on LGBTQ+ people. Here, we contextualize COVID-19 inequities through the history of the HIV/AIDS crisis, describe manifestations of LGBTQ+ structural oppression exacerbated by the pandemic, and provide recommendations for medical professionals and institutions seeking to reduce health inequities.
Collapse
Affiliation(s)
- Raul Macias Gil
- Department of Infectious Diseases, Kaiser Permanente Northern California, Napa/Solano, CA; USA
| | - Tracey Freeman
- Medical Scientist Training Program, University of Pittsburgh-Carnegie Mellon University Pittsburgh, PA; USA
| | - Trini Mathew
- Division of Infectious Diseases and International Medicine, Beaumont Hospital, Royal Oak, MI; USA
| | | | - Anais Ovalle
- Division of Infectious Diseases, Dartmouth Hitchcock Medical Center, Dartmouth, NH, USA
| | - Don Nguyen
- Medical Scientist Training Program, University of Pittsburgh-Carnegie Mellon University Pittsburgh, PA; USA
| | - Angélica Kottkamp
- Division of Infectious Diseases, NYU Grossman School of Medicine, New York, NY; USA
| | - Jin Poon
- Department of Family Medicine, Kaiser Permanente Northern California, Vallejo, CA; USA
| | - Jasmine Marcelin
- Division of Infectious Diseases, University of Nebraska Medical Center, Omaha, NE, USA
| | - Talia H Swartz
- Division of Infectious Diseases, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY; USA
| | | |
Collapse
|
41
|
Grasso C, Goldhammer H, Thompson J, Keuroghlian AS. Optimizing gender-affirming medical care through anatomical inventories, clinical decision support, and population health management in electronic health record systems. J Am Med Inform Assoc 2021; 28:2531-2535. [PMID: 34151934 DOI: 10.1093/jamia/ocab080] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 04/12/2021] [Accepted: 05/03/2021] [Indexed: 01/26/2023] Open
Abstract
Recent advances in electronic health records and health information technology are providing new opportunities to improve the quality of care for transgender and gender diverse people, a population that experiences significant health disparities. This article recommends changes to electronic health record systems that have the potential to optimize gender-affirming care. Specifically, we discuss the importance of creating an anatomical inventory form that captures organ diversity, and of developing clinical decision support tools and population health management systems that consider each patient's gender identity, sex assigned at birth, and anatomy.
Collapse
Affiliation(s)
- Chris Grasso
- The Fenway Institute, Fenway Health, Boston, Massachusetts, USA
| | - Hilary Goldhammer
- National LGBTQIA+ Health Education Center at The Fenway Institute, Fenway Health, Boston, Massachusetts, USA
| | - Julie Thompson
- Transgender Health Program, Medical Department, Fenway Health, Boston, Massachusetts, USA
| | - Alex S Keuroghlian
- Department of Psychiatry, Massachusetts General Hospital/Harvard Medical School, Boston, Massachusetts, USA.,National LGBTQIA+ Health Education Center at The Fenway Institute, Fenway Health, Boston, Massachusetts, USA
| |
Collapse
|
42
|
Thompson HM, Kronk CA, Feasley K, Pachwicewicz P, Karnik NS. Implementation of Gender Identity and Assigned Sex at Birth Data Collection in Electronic Health Records: Where Are We Now? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:6599. [PMID: 34205275 PMCID: PMC8296460 DOI: 10.3390/ijerph18126599] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Revised: 06/13/2021] [Accepted: 06/16/2021] [Indexed: 01/09/2023]
Abstract
In 2015, the United States Department of Health and Human Services instantiated rules mandating the inclusion of sexual orientation and gender identity (SO/GI) data fields for systems certified under Stage 3 of the Meaningful Use of Electronic Health Records (EHR) program. To date, no published assessments have benchmarked implementation penetration and data quality. To establish a benchmark for a U.S. health system collection of gender identity and sex assigned at birth, we analyzed one urban academic health center's EHR data; specifically, the records of patients with unplanned hospital admissions during 2020 (N = 49,314). Approximately one-quarter of patient records included gender identity data, and one percent of them indicated a transgender or nonbinary (TGNB) status. Data quality checks suggested limited provider literacy around gender identity as well as limited provider and patient comfort levels with gender identity disclosures. Improvements are needed in both provider and patient literacy and comfort around gender identity in clinical settings. To include TGNB populations in informatics-based research, additional novel approaches, such as natural language processing, may be needed for more comprehensive and representative TGNB cohort discovery. Community and stakeholder engagement around gender identity data collection and health research will likely improve these implementation efforts.
Collapse
Affiliation(s)
- Hale M. Thompson
- Department of Psychiatry and Behavioral Science, Rush University Medical Center, Chicago, IL 60612, USA; (K.F.); (P.P.); (N.S.K.)
| | - Clair A. Kronk
- Department of Biomedical Informatics, University of Cincinnati College of Medicine, Cincinnati, OH 45267, USA;
| | - Ketzel Feasley
- Department of Psychiatry and Behavioral Science, Rush University Medical Center, Chicago, IL 60612, USA; (K.F.); (P.P.); (N.S.K.)
| | - Paul Pachwicewicz
- Department of Psychiatry and Behavioral Science, Rush University Medical Center, Chicago, IL 60612, USA; (K.F.); (P.P.); (N.S.K.)
| | - Niranjan S. Karnik
- Department of Psychiatry and Behavioral Science, Rush University Medical Center, Chicago, IL 60612, USA; (K.F.); (P.P.); (N.S.K.)
| |
Collapse
|
43
|
Sokkary N, Awad H, Paulo D. Frequency of Sexual Orientation and Gender Identity Documentation After Electronic Medical Record Modification. J Pediatr Adolesc Gynecol 2021; 34:324-327. [PMID: 33333261 DOI: 10.1016/j.jpag.2020.12.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 12/06/2020] [Accepted: 12/08/2020] [Indexed: 01/02/2023]
Abstract
STUDY OBJECTIVE Documentation of sexual orientation (SO) and gender identity (GI) is crucial to identify lesbian, gay, bisexual, and transgender youth and perform meaningful research to improve health disparities in this community. As a result, some electronic medical records (EMRs) have incorporated SO and GI into part of the provider's workflow for documentation. We aimed to evaluate the effect this modification has had on the frequency of SO and GI documentation. DESIGN, SETTING, PARTICIPANTS, INTERVENTIONS, AND MAIN OUTCOME MEASURES: This was a retrospective chart review of patient encounters from an outpatient pediatric and adolescent gynecology clinical practice. The rate of documentation of SO and GI were compared between encounters that took place before the implementation of the EMR modification and those that took place after. Additionally, we examined rates of GI and SO documentation according to visit type and patient race. RESULTS A statistically significant increase in the frequency of SO and GI documentation after the EMR modification was detected. The documentation rate of SO increased from 10/73 (13.7%) to 32/73 (45.1%) (P < .01) and GI documentation rate went from 1.4% to 46.5% (P < .01) after the EMR changes were implemented. SO or GI was most commonly documented in social history (90%). There were no differences in documentation on the basis of race or type of encounter. CONCLUSION Including a specific tab for SO and GI in the EMR significantly increased the frequency of SO and GI documentation. Despite this increase, frequency of documentation remained at less than 50%, emphasizing the need for further improvement.
Collapse
Affiliation(s)
- Nancy Sokkary
- Navicent Health Medical Center, Department of Obstetrics and Gynecology, Macon, Georgia; Mercer University School of Medicine, Macon, Georgia
| | - Hamza Awad
- Mercer University School of Medicine, Macon, Georgia
| | - Dillon Paulo
- Mercer University School of Medicine, Macon, Georgia.
| |
Collapse
|
44
|
Nadler LE, Ogden SN, Scheffey KL, Cronholm PF, Dichter ME. Provider Practices and Perspectives regarding Collection and Documentation of Gender Identity. JOURNAL OF HOMOSEXUALITY 2021; 68:901-913. [PMID: 31526306 PMCID: PMC7676221 DOI: 10.1080/00918369.2019.1667162] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Recent recommendations to include patient sexual orientation (SO) and gender identity (GI) in the electronic health record (EHR) aim to improve clinical care and address health disparities among sexual and gender minority patients. Collection and documentation of GI may be complex due to multiple clinically relevant components. This study explored provider practices in collecting and documenting GI across multiple specialties. Qualitative interviews with 25 healthcare providers were transcribed verbatim, and thematic analysis and principles of grounded theory were used to analyze the data. Without a protocol and absent dedicated locations in the EHR for collecting and documenting patient GI, provider practices were inconsistent and highlighted challenges for communication across clinical staff. Providers noted that patients' disclosure of GI was typically unprompted, or was presumed through disclosure of gender affirming treatments. Findings indicate the need for provider training and appropriate EHR fields to support GI collection and documentation.
Collapse
Affiliation(s)
- Lauren E. Nadler
- Department of Family Medicine, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Shannon N. Ogden
- Department of Family Medicine and Community Health, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Kathryn L. Scheffey
- Department of Family Medicine and Community Health, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Peter F. Cronholm
- Department of Family Medicine and Community Health, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Melissa E. Dichter
- School of Social Work, College of Public Health, Temple University, Philadelphia, Pennsylvania, USA
- Center for Health Equity Research and Promotion, U.S. Department of Veterans Affairs, Philadelphia, Pennsylvania, USA
| |
Collapse
|
45
|
Lau F, Antonio M, Davison K, Queen R, Devor A. A rapid review of gender, sex, and sexual orientation documentation in electronic health records. J Am Med Inform Assoc 2021; 27:1774-1783. [PMID: 32935124 PMCID: PMC7671624 DOI: 10.1093/jamia/ocaa158] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 06/19/2020] [Accepted: 07/22/2020] [Indexed: 12/27/2022] Open
Abstract
Objective The lack of precise and inclusive gender, sex, and sexual orientation (GSSO) data in electronic health records (EHRs) is perpetuating inequities of sexual and gender minorities (SGM). We conducted a rapid review on how GSSO documentation in EHRs should be modernized to improve the health of SGM. Materials and Methods We searched MEDLINE from 2015 to 2020 with terms for gender, sex, sexual orientation, and electronic health/medical records. Only literature reviews, primary studies, and commentaries from peer-reviewed journals in English were included. Two researchers screened citations and reviewed articles with help from a third to reach consensus. Covidence, Excel, and Atlas-TI were used to track articles, extract data, and synthesize findings, respectively. Results Thirty-five articles were included. The 5 themes to modernize GSSO documentation in EHRs were (1) creating an inclusive, culturally competent environment with precise terminology and standardized data collection; (2) refining guidelines for identifying and matching SGM patients with their care needs; (3) improving patient-provider relationships by addressing patient rights and provider competencies; (4) recognizing techno-socio-organizational aspects when implementing GSSO in EHRs; and (5) addressing invisibility of SGM by expanding GSSO research. Conclusions The literature on GSSO documentation in EHRs is expanding. While this trend is encouraging, there are still knowledge gaps and practical challenges to enabling meaningful changes, such as organizational commitments to ensure affirming environments, and coordinated efforts to address technical, organizational, and social aspects of modernizing GSSO documentation. The adoption of an inclusive EHR to meet SGM needs is a journey that will evolve over time.
Collapse
Affiliation(s)
- Francis Lau
- School of Health Information Science, University of Victoria, Victoria, Canada
| | - Marcy Antonio
- School of Health Information Science, University of Victoria, Victoria, Canada
| | - Kelly Davison
- School of Health Information Science, University of Victoria, Victoria, Canada
| | - Roz Queen
- School of Health Information Science, University of Victoria, Victoria, Canada
| | - Aaron Devor
- Department of Sociology, University of Victoria, Victoria, Canada
| |
Collapse
|
46
|
Badowski ME, Britt N, Huesgen EC, Lewis MM, Miller MM, Nowak K, Sherman E, Smith RO. Pharmacotherapy considerations in transgender individuals living with human immunodeficiency virus. Pharmacotherapy 2021; 41:299-314. [PMID: 33404067 DOI: 10.1002/phar.2499] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 12/03/2020] [Accepted: 12/05/2020] [Indexed: 12/28/2022]
Abstract
Pharmacotherapy considerations are often a concern for transgender individuals who are living with human immunodeficiency virus (HIV) due to concerns for drug-drug interactions between their hormone and antiretroviral therapies. Many of the first-line therapies offered to patients for the management of HIV have reduced concerns for safety, resistance, and drug-drug interactions. In this review, we highlight common medications and important considerations for caring for transgender people living with HIV.
Collapse
Affiliation(s)
- Melissa E Badowski
- College of Pharmacy, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Nicholas Britt
- School of Pharmacy, The University of Kansas, Kansas City, Kansas, USA
| | | | - Michelle M Lewis
- Department of Medicine, The University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Misty M Miller
- College of Pharmacy, The University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | | | - Elizabeth Sherman
- College of Pharmacy, Nova Southeastern University, Fort Lauderdale, Florida, USA
| | - Renata O Smith
- College of Pharmacy, University of Illinois at Chicago, Chicago, Illinois, USA
| |
Collapse
|
47
|
Lynch KE, Viernes B, Schliep KC, Gatsby E, Alba PR, DuVall SL, Blosnich JR. Variation in Sexual Orientation Documentation in a National Electronic Health Record System. LGBT Health 2021; 8:201-208. [PMID: 33625876 DOI: 10.1089/lgbt.2020.0333] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Purpose: The purpose of this study was to determine variation in sexual minority (SM) sexual orientation documentation within the electronic medical records of the Veterans Health Administration (VHA). Methods: Documentation of SM sexual orientation was retrospectively extracted from clinical notes and administrative data in the VHA from October 1, 1999 to July 1, 2019. The rate of documentation overall and by calendar year was calculated, and differences across patient, provider, and clinic characteristics were evaluated. Results: Approximately 1.4% of all VHA Veterans (n = 115,911) had at least one documentation of SM sexual orientation, including 79,455 men and 36,456 women. The rate of documentation increased from 81.01/100,000 in 2000 to 568.84/100,000 in 2018. The majority of documentations (58.7%) occurred in mental health settings by non-MD mental health/social work counselors, whereas only 9.6% occurred in primary care settings. Although 99% of these Veterans had a primary care visit, only 19% had SM status recorded in that setting. Conclusion: Documentation patterns of SM sexual orientation varied considerably in the VHA with notable gaps in primary care. Diverse approaches to culturally competent training for primary care clinicians and patient-facing collection strategies could facilitate documentation of sexual orientation.
Collapse
Affiliation(s)
- Kristine E Lynch
- VA Informatics and Computing Infrastructure, VA Salt Lake City Health Care System, Salt Lake City, Utah, USA.,Division of Epidemiology, Department of Internal Medicine, University of Utah, Salt Lake City, Utah, USA
| | - Benjamin Viernes
- VA Informatics and Computing Infrastructure, VA Salt Lake City Health Care System, Salt Lake City, Utah, USA.,Division of Epidemiology, Department of Internal Medicine, University of Utah, Salt Lake City, Utah, USA
| | - Karen C Schliep
- Department of Family and Preventive Medicine, University of Utah, Salt Lake City, Utah, USA
| | - Elise Gatsby
- VA Informatics and Computing Infrastructure, VA Salt Lake City Health Care System, Salt Lake City, Utah, USA
| | - Patrick R Alba
- VA Informatics and Computing Infrastructure, VA Salt Lake City Health Care System, Salt Lake City, Utah, USA.,Division of Epidemiology, Department of Internal Medicine, University of Utah, Salt Lake City, Utah, USA
| | - Scott L DuVall
- VA Informatics and Computing Infrastructure, VA Salt Lake City Health Care System, Salt Lake City, Utah, USA.,Division of Epidemiology, Department of Internal Medicine, University of Utah, Salt Lake City, Utah, USA
| | - John R Blosnich
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, California, USA.,Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, USA
| |
Collapse
|
48
|
Xie F, Getahun D, Quinn VP, Im TM, Contreras R, Silverberg MJ, Baird TC, Nash R, Cromwell L, Roblin D, Hoffman T, Goodman M. An automated algorithm using free-text clinical notes to improve identification of transgender people. Inform Health Soc Care 2020; 46:18-28. [PMID: 33203265 DOI: 10.1080/17538157.2020.1828890] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Accurate identification of transgender persons is a critical first step in conducting transgender health studies. To develop an automated algorithm for identifying transgender individuals from electronic medical records (EMR) using free-text clinical notes. The development and validation of the algorithm was based on data from an integrated healthcare system that served as a participating site in the multicenter Study of Transition Outcomes and Gender. The training and test datasets each contained a total of 300 individuals identified between 2006 and 2014. Both datasets underwent a full medical record review by experienced research abstractors. The validated algorithm was then implemented to identify transgender individuals in the EMR using all clinical notes of patients that received care between January 1, 2015 and June 30, 2018. Validation of the algorithm against the full chart review demonstrated a high degree of accuracy with 97% sensitivity, 95% specificity, 94% positive predictive value, and 97% negative predictive value. The algorithm classified 7,409 individuals (3.5%) as "Definitely transgender" and 679 individuals (0.3%) as "Probably transgender" out of 212,138 candidates with a total of 378,641 clinical notes. The computerized NLP algorithm can support essential efforts to improve the health of transgender people.
Collapse
Affiliation(s)
- Fagen Xie
- Department of Research and Evaluation, Kaiser Permanente Southern California Medical Group , Pasadena, California, USA
| | - Darios Getahun
- Department of Research and Evaluation, Kaiser Permanente Southern California Medical Group , Pasadena, California, USA
| | - Virginia P Quinn
- Department of Research and Evaluation, Kaiser Permanente Southern California Medical Group , Pasadena, California, USA
| | - Theresa M Im
- Department of Research and Evaluation, Kaiser Permanente Southern California Medical Group , Pasadena, California, USA
| | - Richard Contreras
- Department of Research and Evaluation, Kaiser Permanente Southern California Medical Group , Pasadena, California, USA
| | | | - Tisha C Baird
- Department of Endocrinology, Kaiser Permanente Los Angeles Medical Center , Los Angeles, California, USA
| | - Rebecca Nash
- Department of Epidemiology, Emory University School of Public Health , Atlanta, Georgia, USA
| | - Lee Cromwell
- Center for Clinical and Outcomes Research, Kaiser Permanente Georgia , Atlanta, Georgia, USA
| | - Douglas Roblin
- School of Public Health, Georgia State University , Atlanta, Georgia, USA
| | - Trenton Hoffman
- Department of Epidemiology, Emory University School of Public Health , Atlanta, Georgia, USA
| | - Michael Goodman
- Department of Epidemiology, Emory University School of Public Health , Atlanta, Georgia, USA
| |
Collapse
|
49
|
Lau F, Antonio M, Davison K, Queen R, Bryski K. An Environmental Scan of Sex and Gender in Electronic Health Records: Analysis of Public Information Sources. J Med Internet Res 2020; 22:e20050. [PMID: 33174858 PMCID: PMC7688387 DOI: 10.2196/20050] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Revised: 07/03/2020] [Accepted: 10/08/2020] [Indexed: 12/30/2022] Open
Abstract
Background Historically, the terms sex and gender have been used interchangeably as a binary attribute to describe a person as male or female, even though there is growing recognition that sex and gender are distinct concepts. The lack of sex and gender delineation in electronic health records (EHRs) may be perpetuating the inequities experienced by the transgender and gender nonbinary (TGNB) populations. Objective This study aims to conduct an environmental scan to understand how sex and gender are defined and implemented in existing Canadian EHRs and current international health information standards. Methods We examined public information sources on sex and gender definitions in existing Canadian EHRs and international standards communities. Definitions refer to data element names, code systems, and value sets in the descriptions of EHRs and standards. The study was built on an earlier environment scan by Canada Health Infoway, supplemented with sex and gender definitions from international standards communities. For the analysis, we examined the definitions for clarity, consistency, and accuracy. We also received feedback from a virtual community interested in sex-gender EHR issues. Results The information sources consisted of public website descriptions of 52 databases and 55 data standards from 12 Canadian entities and 10 standards communities. There are variations in the definition and implementation of sex and gender in Canadian EHRs and international health information standards. There is a lack of clarity in some sex and gender concepts. There is inconsistency in the data element names, code systems, and value sets used to represent sex and gender concepts across EHRs. The appropriateness and adequacy of some value options are questioned as our societal understanding of sexual health evolves. Outdated value options raise concerns about current EHRs supporting the provision of culturally competent, safe, and affirmative health care. The limited options also perpetuate the inequities faced by the TGNB populations. The expanded sex and gender definitions from leading Canadian organizations and international standards communities have brought challenges in how to migrate these definitions into existing EHRs. We proposed 6 high-level actions, which are to articulate the need for this work, reach consensus on sex and gender concepts, reach consensus on expanded sex and gender definitions in EHRs, develop a coordinated action plan, embrace EHR change from socio-organizational and technical aspects to ensure success, and demonstrate the benefits in tangible terms. Conclusions There are variations in sex and gender concepts across Canadian EHRs and the health information standards that support them. Although there are efforts to modernize sex and gender concept definitions, we need decisive and coordinated actions to ensure clarity, consistency, and competency in the definition and implementation of sex and gender concepts in EHRs. This work has implications for addressing the inequities of TGNB populations in Canada.
Collapse
Affiliation(s)
- Francis Lau
- School of Health Information Science, University of Victoria, Victoria, BC, Canada
| | - Marcy Antonio
- School of Health Information Science, University of Victoria, Victoria, BC, Canada
| | - Kelly Davison
- School of Health Information Science, University of Victoria, Victoria, BC, Canada
| | - Roz Queen
- School of Health Information Science, University of Victoria, Victoria, BC, Canada
| | | |
Collapse
|
50
|
Beyond Gender Identity Disorder Diagnoses Codes: An Examination of Additional Methods to Identify Transgender Individuals in Administrative Databases. Med Care 2020; 58:903-911. [PMID: 32925416 DOI: 10.1097/mlr.0000000000001362] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Large administrative databases often do not capture gender identity data, limiting researchers' ability to identify transgender people and complicating the study of this population. OBJECTIVE The objective of this study was to develop methods for identifying transgender people in a large, national dataset for insured adults. RESEARCH DESIGN This was a retrospective analysis of administrative claims data. After using gender identity disorder (GID) diagnoses codes, the current method for identifying transgender people in administrative data, we used the following 2 strategies to improve the accuracy of identifying transgender people that involved: (1) Endocrine Disorder Not Otherwise Specified (Endo NOS) codes and a transgender-related procedure code; or (2) Receipt of sex hormones not associated with the sex recorded in the patient's chart (sex-discordant hormone therapy) and an Endo NOS code or transgender-related procedure code. SUBJECTS Seventy-four million adults 18 years and above enrolled at some point in commercial or Medicare Advantage plans from 2006 through 2017. RESULTS We identified 27,227 unique transgender people overall; 18,785 (69%) were identified using GID codes alone. Using Endo NOS with a transgender-related procedure code, and sex-discordant hormone therapy with either Endo NOS or transgender-related procedure code, we added 4391 (16%) and 4051 (15%) transgender people, respectively. Of the 27,227 transgender people in our cohort, 8694 (32%) were transmasculine, 3959 (15%) were transfeminine, and 14,574 (54%) could not be classified. CONCLUSION In the absence of gender identity data, additional data elements beyond GID codes improves the identification of transgender people in large, administrative claims databases.
Collapse
|