1. Improving Primary Care for LGBTQ People Andrew Cronyn, MD, FAAP El Rio Health Tucson, Arizona

2. Our Practice 2016 UDS Data Total Number of Patients Served 94, 190
Total Number of Patient Visits
361, 285
Number of Employees
1, 073
Number of Clinical Sites 16
Specialties: IM, FP, Peds, Ob/Gyn, Midwifery, HIV, Dental, Integrated Behavioral Health, Radiology, Lab, Pharmacy

3. El Rio Patients by Race/Ethnicity El Rio Patients by Insurance Source
Our Patients
El Rio Patients by Race/Ethnicity
(2016 Data)
El Rio Patients by Insurance Source
(2016 Data)

4. LGBTQ Timeline: Drivers
10/2014: Adult transgender medicine
Patient complaint  Focus group
11/2014: Pediatric transgender medicine
Identify a Need  Outreach to Community

5. LGBTQ Timeline: Education 10/14-8/16
Community: SAGA, Parents of Rainbow Kids
Conferences: Gender Spectrum, Gender Odyssey
On-line resources: Fenway, UCSF Primary Care Guidelines
On-site: Fenway LGBTQ In-Service, Denver PTC Transgender 201, CHLA Center for Transyouth Health and Development
Human Rights Campaign HEI Certification

6. Transforming Primary Care for LGBT People: Project Aim
To improve health outcomes for LGBT patients served by health centers by increasing the availability of culturally responsible comprehensive primary care.
As in most Collaborative Model, we have a project Aim. This is the aim that has driven the work over the past year.

7. Implementation Collection of SO/GI Data
Project ECHO: Training Medical and Mental Health Providers to Care for LGBTQ Patients
Training Health Center Employees on Culturally Competent Care of LGBTQ Patients
Using SO/GI Data to improve patient care

8. Training LGBTQ 101 Small Groups
Most Important: Front-Line Staff (Desks & Phones)
Personalize (ie: Dental, Gyn, Front Desk)
Resources: Fenway Institute
Create a Culture where it’s OK to say:
“I am uncomfortable with this”
“You made a mistake there”

9. Collecting SO/GI Data: 3/16-Present
1 Provider, 1 Site PDSA Cycle
Expand to 1 Site All Adult Patients
Repeat at 2nd Site (2 hours, one day)
Expand to 2nd Site All Adult Patients
Continuing Education: Culture Shift, Best Medical Practices and Data Collection

10. Partnership With IT Re-design of our data collection form
Looked at best place in practice/EMR system for data to be stored
All staff needed access to this data
Initially designed custom field in practice management system
Final design included fields in EMR, for bi-directional flow of data

11. Universal Data Collection Form

12. Design in Practice Management
Nickname field will be utilized for non-insuranceName

13. EXAMPLE ALERT
This is seen in the EMR and practice and billing system.

14. Kiosk Platform For Data Collection
Late 2016 piloted Kiosk check-in platform at 1 location
It included UDS data elements
Almost 100% data collection for SOGI
Spreading to other sites – completed late 2017
One site- low SOGI data collection (30%) pre-Kiosk platform, now much improved

15. Kiosk Platform For Data Collection

16. Future Software Improvements
Insurance claims- override sex/name
Report data on new fields
Patient searches
Forms/letters- can include new fields

17. Monthly Collection of SO/GI Data in Patients 18+

18. Our Patients

19. Other Results Medical Home for Transgender Youth: 1  60+
Support, Blockers, Hormones and …
PRIMARY CARE
Primary Care for Transgender Patients (adult): unknown  150+
Support, Hormones, Referrals and…
No further patient complaints (in-house)

20. Learning Points
Be slow and deliberate with lots of chances for feedback
Educate EVERYONE
Upper management must be involved
Partner VERY closely with IT
Anticipate staff, providers being nervous
Plan for patient response (but it may not happen)
Adolescents and adults have different needs

21. Who We Are Today
Every Patient Over 13 Asked About Sexual Orientation and Gender Identity
Improved Sexual Health Histories
Every Employee Trained on Systemic Bias in On-Boarding Process
All Employees Annual On-Going LGBTQ Education
Champions in Every Division of the Organization

22. Next Steps Community Education AHCCCS Specialists Hospitals
Name, Gender Changes
Gender Confirmation Surgery