Online Program

Collecting sexual orientation and gender identity information in the emergency department: Patient and provider perspectives from the EQUALITY study

Wednesday, November 4, 2015 : 8:43 a.m. - 8:56 a.m.

Danielle German, PhD, MPH, Department of Health, Behavior & Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
Ryan Shields, Johns Hopkins Medicine, Baltimore, MD
Lisa Kodadek, Johns Hopkins Medicine, Baltimore, MD
Susan Peterson, Johns Hopkins, Baltimore, MD
Clare Snyder, Johns Hopkins, Baltimore
Eric Schneider, Johns Hopkins, Baltimore, MD
Laura Vail, Johns Hopkins, Baltimore, MD
Anju Ranjit, Partners Healthcare, Boston, MA
Maya Torain, Partners Healthcare, Boston
Allysha C. Robinson, MPH, PhD Candidate, Department of Health, Behavior, Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
Jeremiah Schuur, MD, MHS, Department of Emergency Medicine, Brigham and Women’s Hospital, Boston, MA
Brandyn Lau, Department of Surgery, Johns Hopkins University, Baltimore, MD
Adil Haider, Partners Healthcare, Boston, MA
Introduction: Collecting information about sexual orientation and gender identity (SO/GI) during emergency department (ED) admissions would enable investigation of disparities and could enhance patient-centered care. We examined patient, provider, and registrar perspectives and preferences for SO/GI data collection in EDs to inform best practices.   

Methods: Semi-structured interviews conducted 2014-2015 with a diverse purposive sample of heterosexual, lesbian, gay, bisexual, and transgender patients (n=52) and ED nurses, physicians, and registrars (n=35) in a major metropolitan area. Interviews were recorded, transcribed verbatim, and analyzed by multiple coders using constant comparative methods.

Results: A trajectory of the ED care encounter emerged showing key points for collection and SO/GI relevance, with preferences and considerations at each. Comfort and willingness hinged upon data collection purpose (individual medical relevance vs. population health), mode of collection (form-based vs. verbal), privacy protections, interpersonal and environmental cues to safety, and use and flow of information during care encounter. Medical relevance perceptions varied between patients and providers, with greater overall appreciation for GI relevance. Form-based methods were more acceptable across points of care, yet electronic health records posed unique concerns. Participants highlighted that SO/GI information also contextualizes patient relationship/family status and acknowledges LGBT personhood.

Conclusions: Collection of SO/GI in the ED requires attention to patient, provider, and registrar input on methods, operational and institutional aspects, and contexts of data collection and utilization. Ensuring cultural competency, environmental cues to safety, and appropriate use and protections of information will be key considerations as institutions respond to policy recommendations for SO/GI data collection.

Learning Areas:

Clinical medicine applied in public health
Communication and informatics
Diversity and culture
Other professions or practice related to public health
Public health or related organizational policy, standards, or other guidelines
Public health or related public policy

Learning Objectives:
Describe the relevance of sexual orientation and gender identity information for measuring health disparities and informing patient care in emergency department care; Discuss key considerations for collecting sexual orientation and gender identity during emergency department care

Keyword(s): Lesbian, Gay, Bisexual and Transgender (LGBT), Data Collection and Surveillance

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I have been the principal investigator and co-investigator of multiple federally funded grants focusing on health issues among marginalized populations. Among my scientific interests has been the measurement of health disparities among lesbian, gay, bisexual, and transgender individuals
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.