BOSTON, Mass.―A study conducted by researchers from The Fenway Institute and the Center for American Progress and published yesterday in PLOS ONE Journal finds that a diverse group of patients are willing to answer questions about sexual orientation and gender identity in clinical settings, and that they understand the importance of answering questions about sexual orientation and gender identity during the patient registration process. The study also identifies sexual orientation and gender identity questions that can be integrated into existing Electronic Health Records across clinical settings to collect data about health disparities affecting lesbian, gay, bisexual and transgender (LGBT) patients.
The Institute of Medicine and The Joint Commission have each recommended asking questions about sexual orientation and gender identity in clinical settings and including this data in Electronic Health Records. A 2011 report by the Institute of Medicine, The Health of Lesbian, Gay, Bisexual, and Transgender People: Building a Foundation for Better Understanding, noted that routinely collecting data on sexual orientation and gender identity in health care settings is a potent strategy to end LGBT invisibility in health care and eliminate the health disparities experienced by LGBT people. [pullquote]The study also identifies sexual orientation and gender identity questions that can be integrated into existing Electronic Health Records across clinical settings to collect data about health disparities affecting lesbian, gay, bisexual and transgender (LGBT) patients.[/pullquote]
“Routine collection of data about patient sexual orientation and gender identity would give health care providers, public health officials, and researchers the data they need to more accurately evaluate the quality of health care that LGBT people receive, and help them reduce health care disparities experienced by LGBT people,” said Sean Cahill, PhD, Director of Health Policy Research for The Fenway Institute, who was the lead author of the study. Disparities include much lower rates of preventive screenings, such as Pap tests and mammograms, among lesbians and bisexual women, even as they experience rates of cervical and breast cancer similar to those seen among heterosexual women.
“We encourage collection of sexual orientation and gender identity data in clinical settings as without this information LGBT people will remain invisible in health care, perpetuating a documented lack of inclusion and attention to health disparities. Understanding the populations served does carry with it the concomitant responsibility of ensuring that providers are trained about the unique health issues faced by sexual and gender minorities, and that health care environments create environments that are welcoming and inclusive of care for all. “ said Harvey Makadon, MD, a coauthor of the study who directs the National LGBT Health Education Center at The Fenway Institute and is a Professor of Medicine at Harvard Medical School. [pullquote]”Understanding the populations served does carry with it the concomitant responsibility of ensuring that providers are trained about the unique health issues faced by sexual and gender minorities, and that health care environments create environments that are welcoming and inclusive of care for all.”—Harvey Makadon, MD, a coauthor of the study[/pullquote]
Cahill added: “LGBT patients routinely report that they experience discrimination in health care settings related to their sexual orientation or gender identity. We know that there is a dearth of LGBT-inclusive cultural competency and clinical training for health care providers. Collecting data about sexual orientation and gender identity is not only critical to informing policy decisions, but it can help foster discussion in the exam room that will result in more accurate assessments of patient health risks.”
The survey was implemented at four health care centers: Fenway Health, in Boston, MA; Beaufort Jasper Hampton Comprehensive Health Services in rural South Carolina; Chase Brexton Health Center in Baltimore and Columbia, Maryland; and Howard Brown Health Center in Chicago, IL. Survey respondents were predominantly heterosexual (51%) and racially diverse (44% White, 41% Black, 8% Hispanic/Latino/Latina; 5% multiracial, 5% other, 2% Native American/Alaskan Native, and 2% Asian or Pacific Islander).
Some of the key findings reported were:
- An overwhelming majority of respondents (82%) agreed that asking about gender identity on registration forms is important.
- Nearly three in four respondents (74%) agreed that asking about sexual orientation on registration forms is important.
- Most respondents (78%) strongly agreed that they understood all of the choices in the gender identity question.
- There were no statistically significant differences in responses to these questions based on race or geographic location.
- Respondents over age 65 were more likely to answer that they did not understand the choices to the gender identity question.
The study concludes that inclusion of sexual orientation and gender identity questions in collections of patient demographic information should be routine, and that such information will be a powerful tool in ending health care disparities experienced by LGBT people.
In 2012 the federal government decided not to include sexual orientation and gender identity in Stage 2 Meaningful Use Guidelines because of what it called “the lack of consensus for the definition of the concept of gender identity and/or sexual orientation as well as for a standard measure of the concept” and said “we will await further development of a consensus for the goal and standard of measurement for gender identity and/or sexual orientation.” In April 2014 The Fenway Institute, the Center for American Progress, and 151 other LGBT and HIV/AIDS organizations submitted public comment to the Office of the National Coordinator for Health Information Technology in support of including sexual orientation and gender identity questions in Stage 3 Meaningful Use Guidelines. The comment was also signed by several dozen researchers.
To view the report, visit www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0107104.
For more than forty years, Fenway Health has been working to make life healthier for the people in our neighborhood, the LGBT community, people living with HIV/AIDS and the broader population. The Fenway Institute at Fenway Health is an interdisciplinary center for research, training, education and policy development focusing on national and international health issues. Fenway’s Sidney Borum Jr. Health Center cares for youth and young adults ages 12 to 29 who may not feel comfortable going anywhere else, including those who are LGBT or just figuring things out; homeless; struggling with substance use; or living with HIV/AIDS. In 2013, AIDS Action Committee of Massachusetts joined the Fenway Health family, allowing both organizations to improve delivery of care and services across the state and beyond.
[From a News Release]