"People want to be normalized," Dr. Adil Haider, Kessler director for the Center for Surgery and Public Health at Brigham and Women's Health told Healthcare Dive in preparation for his presentation this morning at AcademyHealth's Annual Research Meeting. "We need to figure out what's the best way to ask people this question."
Haider and colleagues designed a three-phase study (the EQUALITY Study) to assess barriers and preferred approaches to sexual orientation/gender identity (SO/GI) collection; develop and prioritize patient-centered approaches to such collection; and evaluate the effectiveness of such collection approaches in the emergency department setting.
Background surrounding the study
There are 136.3 million ER visits annually, according to the Centers for Disease Control and Prevention. Data surrounding how many that identify as LGBT in the U.S. vary a bit. The CDC's 2014 National Health Interview Survey found 1.6% of respondents identified as gay or lesbian and 0.7% identified as bisexual. A 2015 Gallup estimate stated 3.8% of the American public identify as LGBT. Using the CDC and Gallup figures, a range of about 2.18 million to 5.17 million individuals who identify as LGBT could be presenting themselves to the ED annually.
In the Stage 3 Meaningful Use final rule (page 408), the Office of the National Coordinator for Health IT required EHRs to give providers the ability to record, change, access sexual orientation/gender identity data. "CMS and ONC believe including SO/GI in the 'demographics' criterion represents a crucial step forward to improving care for LGBT communities," the rule stated.
"The most important thing is to ensure we are treating everybody equally and there are no major disparities between patients that we treat," Haider stated. He added there is data that suggest there are healthcare disparities with LGBT populations "but unless we collect this data, we would never know where the disparities are and how we're going to fix them."
The researchers surveyed a total of 1,516 individuals (244 lesbian, 289 gay, 179 bisexual and 804 straight) and 429 providers (209 physicians and 220 nurses).
The study found while 80% of ED providers expressed concerns about offending patients when inquiring about sexual orientation information, only 11% of patient respondents indicated they would be offended.
Only 0.7% of patient respondents indicated they would refuse to disclose their sexual orientation and 8.9% of providers indicated they would refuse to ask patients such a disclosure. The study found non-verbal self-reporting was the preferred method among both patient and provider respondents.
As the site of one-quarter of acute unscheduled care visits in the U.S., the ED is an important location for collection of sexual orientation data, the reasearchers note. In addition, ED patients are receiving care from providers who are new to them, which can complicate the provision of patient-centered care.
The first two phases of the study have led to the development of the final phase: a multi-site matched cohort study designed to evaluate two SO/GI collection methods’ comparative effect on SO/GI collection response rates and patient-reported outcomes.
The MU Stage 3 final rule only required the data fields to be present, not for eligible providers and hospitals to actually collect such data.
Haider noted the industry still hasn't figured out the right way to ask this information, adding there needs to be a mechanism for those that want to disclose such information to be able to do so in a safe and comfortable environment. While some providers may be uncomfortable asking such demographic data, Haider says, from the patient perspective, some individuals go into the care setting thinking, "You're my doctor. You're treating me. This is who I am. I want you to know who I am so that you can treat me as an individual."
“To provide the best care, it’s important that we understand patients when they’re at their most vulnerable,” said Brandyn Lau, MPH, the study’s senior author and assistant professor of surgery at Johns Hopkins School of Medicine, said in a prepared statement. “But the first step in evaluating emergency care is gathering the data. Right now, we don’t have the data because it is not being routinely collected in a standardized manner."