Michael S Dunbar1, Jaclyn M W Hughto2,3,4,5, Guneet K Jasuja6,7, Emily K Quinn7, Madeline Deutsch8,9, Asa Radix10, Jamie Feldman11, Jennifer Abbott12, Joshua D Safer13, Julie Thompson14, Adam J Rose15,16. 1. Health Care Division, RAND Corporation, Pittsburgh, Pennsylvania, USA. 2. Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, Rhode Island, USA. 3. Department of Epidemiology, Brown University School of Public Health, Providence, Rhode Island, USA. 4. Center for Health Promotion and Health Equity, Brown University, Providence, Rhode Island, USA. 5. The Fenway Institute, Fenway Health, Boston, Massachusetts, USA. 6. Center for Healthcare Organization and Implementation Research (CHOIR), Edith Nourse Memorial Veterans Hospital, Bedford VA Medical Center, Bedford, Massachusetts, USA. 7. Boston University School of Medicine, Boston, Massachusetts, USA. 8. UCSF Transgender Care, University of California, San Francisco, San Francisco, California, USA. 9. Department of Family & Community Medicine, UCSF School of Medicine, University of California, San Francisco, San Francisco, California, USA. 10. Callen-Lorde Community Health Center, New York, New York, USA. 11. Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, Minnesota, USA. 12. Western North Carolina Community Health Services, Asheville, North Carolina, USA. 13. Mount Sinai Center for Transgender Medicine and Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA. 14. Fenway Health, Boston, Massachusetts, USA. 15. Department of Health Policy, School of Public Health, Hebrew University, Jerusalem, Israel. 16. OptumLabs, Eden Prairie, Minnesota, USA.
Abstract
Purpose: Transgender (TG) individuals are a historically understudied and underserved patient population. Although clinical guidelines for the care of TG patients exist, quality measures (QMs) specific to this population are lacking. The goal of this study was to obtain expert input on aspects of care for which quality measurement may be appropriate and describe feedback on candidate QMs. Methods: We convened a virtual technical expert panel in September 2020 with six experts in TG medical care. Experts participated in a guided discussion and provided numeric ratings on dimensions of measure suitability (importance, validity/reliability, feasibility, and ease of understanding) for eight candidate QMs spanning multiple care domains (e.g., laboratory testing/monitoring, cancer screening, and sexually transmitted infection screening). Results: Panelists acknowledged high importance and potential to improve care for some candidate QMs, particularly those related to laboratory testing before initiating and during hormone therapy. Numeric ratings of QMs varied but tended to be higher for testing-focused QMs. Experts raised concerns about overly prescriptive language for some QMs and emphasized the importance of considering more flexible specifications to accommodate diverse care scenarios-including care provided to nonbinary individuals-and align with the individualized nature of gender-affirming care. Conclusion: These preliminary findings support a potential role for QMs in improving quality of care for TG patients. Measures related to laboratory testing/monitoring for patients who receive or plan to initiate hormone therapy may be feasible and promising to explore in the future. Additional larger-scale efforts are needed to develop and test QMs for the care of TG individuals.
Purpose: Transgender (TG) individuals are a historically understudied and underserved patient population. Although clinical guidelines for the care of TG patients exist, quality measures (QMs) specific to this population are lacking. The goal of this study was to obtain expert input on aspects of care for which quality measurement may be appropriate and describe feedback on candidate QMs. Methods: We convened a virtual technical expert panel in September 2020 with six experts in TG medical care. Experts participated in a guided discussion and provided numeric ratings on dimensions of measure suitability (importance, validity/reliability, feasibility, and ease of understanding) for eight candidate QMs spanning multiple care domains (e.g., laboratory testing/monitoring, cancer screening, and sexually transmitted infection screening). Results: Panelists acknowledged high importance and potential to improve care for some candidate QMs, particularly those related to laboratory testing before initiating and during hormone therapy. Numeric ratings of QMs varied but tended to be higher for testing-focused QMs. Experts raised concerns about overly prescriptive language for some QMs and emphasized the importance of considering more flexible specifications to accommodate diverse care scenarios-including care provided to nonbinary individuals-and align with the individualized nature of gender-affirming care. Conclusion: These preliminary findings support a potential role for QMs in improving quality of care for TG patients. Measures related to laboratory testing/monitoring for patients who receive or plan to initiate hormone therapy may be feasible and promising to explore in the future. Additional larger-scale efforts are needed to develop and test QMs for the care of TG individuals.
Entities:
Keywords:
gender-affirming care; quality measurement; quality of care; transgender
Authors: Jaclyn M White Hughto; Gabriel R Murchison; Kirsty Clark; John E Pachankis; Sari L Reisner Journal: LGBT Health Date: 2016-09-16 Impact factor: 4.151
Authors: Wylie C Hembree; Peggy T Cohen-Kettenis; Louis Gooren; Sabine E Hannema; Walter J Meyer; M Hassan Murad; Stephen M Rosenthal; Joshua D Safer; Vin Tangpricha; Guy G T'Sjoen Journal: J Clin Endocrinol Metab Date: 2017-11-01 Impact factor: 5.958
Authors: Bernard M Branson; H Hunter Handsfield; Margaret A Lampe; Robert S Janssen; Allan W Taylor; Sheryl B Lyss; Jill E Clark Journal: MMWR Recomm Rep Date: 2006-09-22