Comparing ways to ask patients about sexual orientation and gender identity in the emergency room : the EQUALITY study / Adil Haider.

Format:

Book

Author/Creator:

Haider, Adil, author.

Series:

Final research report (Patient-Centered Outcomes Research Institute (U.S.))

Language:

English

Subjects (All):

Gender identity.

Physical Description:

1 online resource (214 pages) : illustrations.

Other Title:

Comparing ways to ask patients about sexual orientation and gender identity in the emergency room

Place of Publication:

Washington, DC : Patient-Centered Outcomes Research Institute, 2019.

Summary:

BACKGROUND: Lack of data on sexual orientation and gender identity (SO/GI) is a major challenge to understanding and addressing sexual and gender minority (SGM) health disparities. National organizations recommend routine collection of SO/GI information in electronic health records to help identify and address these health disparities. In the United States, there are nearly 130 million emergency department (ED) visits every year. Despite the importance of SO/GI for providing high-quality, patient-centered care and the opportunity to collect a high volume of SO/GI information for SGM disparities research, routine collection of SO/GI in the ED setting is rare, and optimal patient-centered approaches remain unclear. OBJECTIVES: The overall aim of this sequential mixed-methods study was to develop and evaluate the comparative effectiveness of patient-centered approaches for collecting SO/GI in the ED setting. The specific aims were to (1) gather qualitative input on perceived facilitators, barriers, and preferred approaches for collecting SO/GI in the ED setting; (2) develop and prioritize patient-centered approaches for collecting SO/GI; and (3) evaluate the comparative effectiveness of 2 patient-centered approaches, identified in aim 2, for collecting SO/GI in the ED setting. METHODS: The Emergency Department Query for Patient-Centered Approaches to Sexual Orientation and Gender Identity Study used a multiphase mixed-methods design. Phase 1 consisted of qualitative and quantitative data collection. This included in-depth interviews with a purposive sample of patients and ED providers from 1 major city in the Mid-Atlantic United States and a nationally representative phone survey of patients, ED physicians, and nurses, to identify facilitators, barriers, and preferred methods to collect SO/GI in the ED. Phase 2 used data from phase 1 in modified Delphi rounds that resulted in stakeholder advisory board (SAB) members identifying 2 methods of SO/GI collection to implement in a trial. In phase 3, we sequentially implemented and evaluated 2 methods of SO/GI collection--verbal collection by nurses (mode 1) and nonverbal self-report during registration (mode 2)--in 4 hospital EDs in the Northeast and Mid-Atlantic United States. We assessed ED patient satisfaction and comfort using average modified Communication Climate Assessment Toolkit Questionnaire (CCAT) scores as advised by our SAB. We invited all eligible patients to complete outcome surveys. We calculated primary and secondary outcome results using analysis of variance (ANOVA) or chi-square tests between modes for each patient match group. We used multivariable ordered logistic regression to examine whether intervention mode was associated with modified CCAT scores after controlling for potential confounding variables: age, race, illness severity, and hospital site. RESULTS: In phase 1, a total of 53 patients and 38 physicians, nurses, and registrars participated in qualitative interviews. Interviews revealed that, although patients believed SO/GI was important in all clinical circumstances, clinicians thought SO/GI was rarely important. The online survey confirmed these findings on the national level. In total, 1617 patients (244 lesbian, 289 gay, 179 bisexual, 101 transgender, and 804 heterosexual and cisgender) and 429 providers (209 physicians, 220 nurses) completed the national survey. Among patients, only 10.1% refused to provide SO, whereas 77.8% of clinicians believed patients would refuse to provide SO. Similarly, only 7.4% of patients refused to provide GI, whereas 73.4% of clinicians believed patients would refuse to provide GI. In phase 2, SAB members used findings from phase 1 to identify 2 methods to collect SO/GI information and test in an interventional study: verbal collection by nurses during patient assessment (mode 1) vs nonverbal self-report during patient registration (mode 2). SAB members highlighted the importance of staff education and training, provided important direction for trial implementation, and approved the outcome measures used in phase 3 below. In phase 3, CCAT scores (on a scale of 0-100) during mode 1 were 89.5 (SD, 20.5; 95% CI, 85.7-93.3), 91.8 (SD, 18.9; 95% CI, 88.3-95.3), and 92.7 (SD, 15.9; 95% CI, 89.8-95.7) for SGM, non-SGM, and Blank Field patients (those who did not list SO/GI information), respectively. During mode 2, average modified CCAT scores were 95.6 (SD, 11.9; 95% CI, 92.7-98.5; P < .05), 93.2 (SD, 13.6; 95% CI, 89.9-96.5; P = .591), and 93.6 (SD, 14.7; 95% CI, 90.0-97.2; P = .703) among SGM, non-SGM, and Blank Field patients. Modified CCAT scores were significantly higher among SGM patients only. The SAB was involved in analyzing these results and provided guidance on their interpretation and communication. CONCLUSIONS: The vast majority of patients are willing to provide SO/GI in the ED. Patients report higher satisfaction and comfort with ED encounters when SO/GI is collected along with other demographic information via a nonverbal, written method during patient registration. Our results highlight the importance of patient-centered approaches to training, technical assistance, and implementation for effectively integrating SO/GI information collection in ED settings.

Contents:

Background

Patient and Stakeholder Involvement

Methods

Results

Discussion

Conclusions

References

Publications

Acknowledgment

Appendices.

Notes:

Description based on publisher supplied metadata and other sources.