Improving equitable access to inclusive sexual healthcare in a small urban college health setting.

BACKGROUND: Sexual and gender minorities (SGM) experience many disparities in sexual health. College health centers must address early inequities for this population. LOCAL PROBLEM: Significant access disparity was noted for SGM students at a small urban college health center. The aim of this quality initiative was to increase equitable access by 20% over 90 days. METHODS: A rapid-cycle quality improvement project was initiated using a Plan-Do-Study-Act model. INTERVENTIONS: Templated nurse-led visits, a discussion starter tool, and an inclusive care checklist were introduced, with assurance of equity for each metric, and a focus on team collaboration. RESULTS: Access to sexual health services increased by 22.6% over 8 weeks with SGM utilization increasing 2.7-fold. Guideline-concordant care improved by 94% for all students. Student comfort scores (Likert range 1-5) also improved, from a baseline of 3.53 to a project mean of 4.62. CONCLUSIONS: This project addressed equity in a college health setting through improved student engagement, targeted workflow innovation, and enhanced team collaboration. Application of key findings to other health topics will continue to mitigate disparities in college health centers. Tools may also be applied to adolescent and adult primary care settings to improve patient comfort and SGM-inclusive sexual health service delivery.

Implementing a Safety Bundle to Improve Screening and Care for Perinatal Mood and Anxiety Disorders.

OBJECTIVE: To improve screening and care of individuals with perinatal mood and anxiety disorders (PMAD) through the implementation of a perinatal mental health safety bundle. DESIGN: Rapid-cycle quality improvement model using four plan-do-study-act cycles over the course of 90 days. Individuals between 28 and 32 weeks gestation and at their 6-week postpartum follow-up visit were screened and offered stage-based care for PMAD. SETTING/LOCAL PROBLEM: At baseline, only 15% of clients of a suburban, private-practice women's health clinic were receiving PMAD screening with a validated tool, and the site lacked standardized PMAD care practices among health care providers. PARTICIPANTS: Health care providers (n = 2), staff (n = 4), and eligible patients (n = 78) at a private-practice women's health clinic. INTERVENTION/MEASUREMENTS: A screening, brief intervention, referral, and treatment/follow-up (SBIRT) model was used to screen eligible patients, provide treatment options, and appropriately refer for follow-up to mental health services. Team engagement occurred via weekly meetings. Measurements included pre-post maternal and team engagement survey results, biweekly chart review, and run chart analysis. RESULTS: Effective PMAD screening and right care were achieved for 85% of eligible individuals; this included receiving screening, referral to treatment, a scheduled mental health appointment, and clinic follow-up to ensure mental health care uptake. CONCLUSION: Use of the SBIRT model to implement a safety bundle may contribute to improved mental health outcomes for individuals receiving perinatal care in a private-practice outpatient health care setting. Education and engagement among clinicians, staff, and patients are key to successful implementation of a safety bundle.