A Quality Improvement Approach to Enhance LGBTQ+ Inclusivity in Pediatric Primary Care

BACKGROUND Lesbian, gay, bisexual, transgender, and queer (LGBTQ+) teens are at higher risk of illness as a result of bias but are less likely than peers to attend well visits. Medical organizations recommend improving care through staff education, visual cues, and routine inquiry of sexual orientat...

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Bibliographic Details
Published in:Pediatrics (Evanston) 2022-08, Vol.150 (2), p.1
Main Authors: McKinnish, Tyler, Hunt, Candice, Weinberg, Steven, Perry, Martha, Seashore, Carl, Gold, Stuart, Vander Schaaf, Emily B.
Format: Article
Language:English
Subjects:
Bisexuality
Gender identity
Inclusion
Orientation behavior
Patients
Pediatrics
Primary care
Quality control
Quality improvement
Sexual behavior
Transgender persons
Visual stimuli
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Summary:BACKGROUND Lesbian, gay, bisexual, transgender, and queer (LGBTQ+) teens are at higher risk of illness as a result of bias but are less likely than peers to attend well visits. Medical organizations recommend improving care through staff education, visual cues, and routine inquiry of sexual orientation and gender identity (SO/GI) and pronouns. It is unknown how to do this confidentially in pediatrics. This quality improvement (QI) project aimed to confidentially collect and document SO/GI and pronouns early in at least 90% of teen acute care visits. METHODS A diverse, representative QI team in a resident primary care clinic conducted a series of staff and clinician trainings to improve knowledge, then displayed welcoming signage and offered staff pronoun and rainbow pins. Multiple Plan-Do-Study-Act cycles developed methods of routine and private collection of SO/GI and pronouns. Outcome measures included proportion of teen acute visits with such documentation collected via weekly chart reviews. Process measures included staff/clinician preparedness, assessed by surveys. RESULTS SO/GI and pronouns were documented in 0% of teen acute visits at baseline, 70% after 6 months, and 90% during the 20-week sustainment measurement phase. The proportion of staff and clinicians who felt prepared to provide care for LGB and transgender patients increased (53% to 68% for LGB, P = .07; and 30% to 57% for transgender, P = .002). CONCLUSIONS QI methods can create protocols for confidential, sustainable SO/GI and pronoun collection from teens early in acute visits. This allows clinicians and staff to address patients appropriately and for clinicians to better meet their needs.
ISSN:0031-4005
1098-4275
DOI:10.1542/peds.2021-052125