Transforming Primary Care for Lesbian, Gay, Bisexual, and Transgender People: A Collaborative Quality Improvement Initiative

Authors

Bruce W. Furness, Division of Sexually Transmitted Disease Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
Hilary Goldhammer, The Fenway Institute, Fenway Health, Boston, Massachusetts
Wanda Montalvo, Jonas Nursing & Veterans Healthcare, Columbia University, New York, New York; Weitzman Institute, Community Health Center, Inc, Middletown, Connecticut
Kelly Gagnon, Weitzman Institute, Community Health Center, Inc, Middletown, Connecticut; University of Pittsburgh, Graduate School of Public Health, Pittsburgh, Pennsylvania
Lauren Bifulco, Weitzman Institute, Community Health Center, Inc, Middletown, Connecticut
Daniel Lentine, Division of Sexually Transmitted Disease Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
Daren Anderson, Weitzman Institute, Community Health Center, Inc, Middletown, Connecticut

Document Type

Article

Publication Date

8-2020

Abstract

PURPOSE Lesbian, gay, bisexual, and transgender (LGBT) people experience multiple disparities in access to care and health outcomes. We developed a quality improvement initiative, Transforming Primary Care for LGBT People, to enhance the capacity of federally qualified health centers (FQHCs) to provide culturally affirming care for this population.

METHODS The 1-year intervention blended the models of Practice Improvement Collaboratives and Project ECHO (Extension for Community Health Outcomes) to facilitate learning and translate knowledge into action. FQHC teams received coaching in creating LGBT-inclusive environments, collecting sexual orientation and gender identity (SOGI) data, taking risk-based sexual histories, and screening LGBT people for syphilis, chlamydia and gonorrhea, and HIV. We used a preintervention-postintervention evaluation design.

RESULTS We selected 10 FQHCs serving 441,387 patients in 123 clinical sites in 9 states. The intervention spread from 10 clinicians in 10 clinical sites to 431 clinicians in 79 clinical sites. FQHCs reported increases in culturally affirming practices, including collecting patient pronoun information (42.9% increase) and identifying LGBT patient liaisons (300.0% increase). Postintervention, among 9 FQHCs reporting SOGI data from electronic health records, SOGI documentation increased from 13.5% to 50.8% of patients (276.3% increase). Among 8 FQHCs reporting number of LGBT patients, screening of LGBT patients increased from 22.3% (95% CI, 4.9%-40.0%) to 34.6% (95% CI, 19.4%-48.6%) for syphilis (86.5% increase); from 25.3% (95% CI, 7.6%-43.1%) to 44.1% (95% CI, 30.2%58.1%) for chlamydia and gonorrhea (109.0% increase); and from 14.8% (95% CI, 3.2%-26.5%) to 30.5% (95% CI, 26.7%-34.3%) for HIV (132.4% increase).

CONCLUSIONS FQHCs participating in this initiative reported improved capacity to provide culturally affirming care and targeted screening for LGBT patients.

Recommended Citation

Furness, B. W., Goldhammer, H., Montalvo, W., Gagnon, K., Bifulco, L., Lentine, D., & Anderson, D. Transforming primary care for lesbian, gay, bisexual, and transgender people: A collaborative quality improvement initiative. The Annals of Family Medicine. 2020; 18(4), 292-302. https://doi.org/10.1370/afm.2542