A Model for Improving Health Care Quality for Transgender and Gender Nonconforming Patients

https://doi.org/10.1016/j.jcjq.2019.09.005Get rights and content

Problem Definition

Transgender and gender nonconforming (TGNC) populations are disproportionately affected by limited health care access and poor health outcomes and commonly report discrimination and mistreatment in health care settings. Despite these disparities, comprehensive approaches to improve the quality of health care of TGNC patient populations are currently lacking.

Initial Approach

The Vanderbilt Program for LGBTQ Health has developed a multifaceted, community-engaged approach to improve the quality of health care of TGNC patients, which includes the creation of a transgender patient advocacy program, a community advisory board, and a transgender health clinic. To support the continuous quality improvement of transgender health care, the program is currently piloting a novel multilevel monitoring and evaluation (M&E) system to collect information at the individual patient visit and health systems levels.

Next Steps

The next steps for Vanderbilt's community-engaged M&E system are to identify the clinics and health services most used by TGNC patients and assess the level of patient satisfaction in each area. This process will support the identification of high- and low-performing clinics and health services and allow for targeted delivery of trainings to improve the quality of culturally competent health care TGNC patients receive systemwide.

Conclusion

In collaboration with TGNC patient populations and community stakeholders, Vanderbilt has created a model to improve the quality of both transition- and non-transition-related health care at the systems level that can be adopted by other health care systems nationally.

Section snippets

Problem Definition

An estimated 1.4 million adults, or 0.6% of the adult population of the United States, identify as transgender.1 Current health care experiences of transgender and gender nonconforming (TGNC) patients, including both transition- (hormone replacement therapy, gender affirmation surgery, and so forth) and non-transition-related (care unrelated to a patient's TGNC identity), are often substandard and variable. Many TGNC patients choose not to seek medical help when necessary because they fear

Initial Approach

To improve the quality of health care for TGNC patients at both the patient-provider and health-systems levels, the Vanderbilt Program for LGBTQ Health has invested in the development of TGNC patient–specific initiatives since 2014. These include Trans Buddy, a transgender patient peer advocacy program (in which volunteers advocate and provide emotional/logistical support for trans patients during their health care visits), a community advisory board that includes both TGNC community members

Next Steps

As the number of TGNC patients identified within the VUMC health system increases due to the rollout of the new SOGI interface and growth of the Clinic for Transgender Health, analyses of patient clinical utilization and health outcomes will support identification of both provider-level and systems-level quality challenges and successes of the health care received by TGNC patient populations at VUMC. A key future direction is the semiautomated development of individualized reports to be

Conclusion

Currently, TGNC health care quality is substandard and variable, resulting in higher instances of negative health care experiences and contributing to poor health outcomes for TGNC patients. To address the dearth of systems-level TGNC quality of health care initiatives, Vanderbilt has developed and piloted a multifaceted, health systems–level approach to improving TGNC quality of care, one rooted in transgender community feedback through community outreach programs and clinical informatics

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