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

Abstract

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.

Figure 1:

This figure depicts Vanderbilt’s multilevel, community-engaged health systems model to improve the quality of care provided to transgender and gender nonconforming (TGNC) patient populations. All quality improvement activities center feedback from TGNC community stakeholders and patients via input from the community advisory board (CAB). Current programmatic initiatives to improve TGNC quality of care include the Trans Buddy patient advocacy program, the Clinic for Transgender Health, and trainings to improve the quality of health care provided generally to TGNC patients. The effectiveness of these programs is evaluated using a case-note report form that Trans Buddies and TGNC patients complete together and return to Program for LGBTQ Health staff, as well as ongoing clinical informatics approaches to identify TGNC patient population health outcomes across the institution. Vanderbilt is actively working on expanding the sophistication of its monitoring and evaluation systems to return results of quality studies to health care providers, the CAB, and TGNC patients to continuously improve the quality of care offered to TGNC patients. EHR, electronic health record.