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. 2021 Sep;73(3):723-733.
doi: 10.1007/s12020-021-02748-4. Epub 2021 May 21.

"Good practices" in pediatric clinical care for disorders/differences of sex development

Grace L Kavanaugh  1   2 , Lauren Mohnach  3 , Janey Youngblom  1 , Joshua G Kellison  2   4 , David E Sandberg  5   6 ; Accord Alliance
Collaborators, Affiliations

"Good practices" in pediatric clinical care for disorders/differences of sex development

Grace L Kavanaugh et al. Endocrine. 2021 Sep.

Abstract

Purpose: To define, benchmark, and publicize elements of quality care (i.e., "good practices") for pediatric patients with disorders/differences of sex development (DSD).

Methods: Principles of quality care were identified by literature review; consensus exists for 11 good practices and adherence was evaluated through online survey of 21 North American clinical sites.

Results: Strong uptake was observed for many practices, particularly specialty participation (n ≥ 17 of 21 sites for most core specialties); point of contact (n = 18); expertise in gender dysphoria/dissatisfaction (n = 20); and DSD-specific continuing medical education (n = 18). Greater variability was apparent for frequency of peer support referrals (n = 12 universally practiced); standardized questionnaires for routine assessment of psychosocial adaptation (n = 13) and gender development (n = 10); consistently clarifying patient/family values in decision-making (n = 15); genital exam protocols that exclude trainee education as primary reason (n = 15); and internal patient-tracking efforts (n = 5-10 of 20 sites).

Conclusion: This study employed a novel approach to designate DSD good practices and identified areas of consistency and variation in these DSD clinical practices. Good practice benchmarking facilitates quality assessment within and across sites, promotes continuous improvement, and empowers stakeholders in locating and delivering high quality care.

Keywords: Benchmarking; Disorders of sex development; Guideline; Quality improvement.

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Conflict of interest statement

Declarations

Conflicts of interest/Competing interests - The authors have no conflicts of interest to declare.

Figures

Fig. 1
Fig. 1
a. Specialists involved in the care of pediatric patients with DSD at site, but not necessarily within a dedicated DSD clinic. n = 21 sites Fig. 1b Specialists involved in the care of pediatric patients with DSD within a dedicated DSD clinic at site. n = 18 sites
Fig. 2
Fig. 2
Frequency of use of standardized questionnaires and clinical interviews to assess for psychological adaptation and gender development. n = 21 sites
Fig. 3
Fig. 3
Connecting families to support organizations. n = 21 sites A: Do providers encourage families to contact support organizations? B: How frequently do providers raise the topic of DSD support organizations with families?
See this image and copyright information in PMC

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