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

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...

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Bibliographic Details
Published in:Endocrine 2021-09, Vol.73 (3), p.723-733
Main Authors: Kavanaugh, Grace L., Mohnach, Lauren, Youngblom, Janey, Kellison, Joshua G., Sandberg, David E.
Format: Article
Language:English
Subjects:
Decision making
Diabetes
Endocrinology
Gender
Humanities and Social Sciences
Internal Medicine
Literature reviews
Medicine
Medicine & Public Health
multidisciplinary
Original Article
Patients
Pediatrics
Quality control
Science
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Summary: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.
ISSN:1355-008X
1559-0100
DOI:10.1007/s12020-021-02748-4