Improving Primary Care for LGBTQ People Andrew Cronyn, MD, FAAP El Rio Health Tucson, Arizona

Our Practice 2016 UDS Data Total Number of Patients Served 94, 190 Total Number of Patient Visits 361, 285 Number of Employees 1, 073 Number of Clinical Sites 16 Specialties: IM, FP, Peds, Ob/Gyn, Midwifery, HIV, Dental, Integrated Behavioral Health, Radiology, Lab, Pharmacy

El Rio Patients by Race/Ethnicity El Rio Patients by Insurance Source Our Patients El Rio Patients by Race/Ethnicity (2016 Data) El Rio Patients by Insurance Source (2016 Data)

LGBTQ Timeline: Drivers 10/2014: Adult transgender medicine Patient complaint  Focus group 11/2014: Pediatric transgender medicine Identify a Need  Outreach to Community

LGBTQ Timeline: Education 10/14-8/16 Community: SAGA, Parents of Rainbow Kids Conferences: Gender Spectrum, Gender Odyssey On-line resources: Fenway, UCSF Primary Care Guidelines On-site: Fenway LGBTQ In-Service, Denver PTC Transgender 201, CHLA Center for Transyouth Health and Development Human Rights Campaign HEI Certification

Transforming Primary Care for LGBT People: Project Aim To improve health outcomes for LGBT patients served by health centers by increasing the availability of culturally responsible comprehensive primary care. As in most Collaborative Model, we have a project Aim. This is the aim that has driven the work over the past year.

Implementation Collection of SO/GI Data Project ECHO: Training Medical and Mental Health Providers to Care for LGBTQ Patients Training Health Center Employees on Culturally Competent Care of LGBTQ Patients Using SO/GI Data to improve patient care

Training LGBTQ 101 Small Groups Most Important: Front-Line Staff (Desks & Phones) Personalize (ie: Dental, Gyn, Front Desk) Resources: Fenway Institute Create a Culture where it’s OK to say: “I am uncomfortable with this” “You made a mistake there”

Collecting SO/GI Data: 3/16-Present 1 Provider, 1 Site PDSA Cycle Expand to 1 Site All Adult Patients Repeat at 2nd Site (2 hours, one day) Expand to 2nd Site All Adult Patients Continuing Education: Culture Shift, Best Medical Practices and Data Collection

Partnership With IT Re-design of our data collection form Looked at best place in practice/EMR system for data to be stored All staff needed access to this data Initially designed custom field in practice management system Final design included fields in EMR, for bi-directional flow of data

Universal Data Collection Form

Design in Practice Management Nickname field will be utilized for non-insuranceName

EXAMPLE ALERT This is seen in the EMR and practice and billing system.

Kiosk Platform For Data Collection Late 2016 piloted Kiosk check-in platform at 1 location It included UDS data elements Almost 100% data collection for SOGI Spreading to other sites – completed late 2017 One site- low SOGI data collection (30%) pre-Kiosk platform, now much improved

Kiosk Platform For Data Collection

Future Software Improvements Insurance claims- override sex/name Report data on new fields Patient searches Forms/letters- can include new fields

Monthly Collection of SO/GI Data in Patients 18+

Our Patients

Other Results Medical Home for Transgender Youth: 1  60+ Support, Blockers, Hormones and … PRIMARY CARE Primary Care for Transgender Patients (adult): unknown  150+ Support, Hormones, Referrals and… No further patient complaints (in-house)

Learning Points Be slow and deliberate with lots of chances for feedback Educate EVERYONE Upper management must be involved Partner VERY closely with IT Anticipate staff, providers being nervous Plan for patient response (but it may not happen) Adolescents and adults have different needs

Who We Are Today Every Patient Over 13 Asked About Sexual Orientation and Gender Identity Improved Sexual Health Histories Every Employee Trained on Systemic Bias in On-Boarding Process All Employees Annual On-Going LGBTQ Education Champions in Every Division of the Organization

Next Steps Community Education AHCCCS Specialists Hospitals Name, Gender Changes Gender Confirmation Surgery