"I Think There's Only Two Fields for That": Hospital Registrar Attitudes and Practices for Collecting Patient Gender Identity Data.

Purpose: This study aimed to understand the experiences of hospital registrars in collecting gender identity data. Methods: A qualitative study that thematically analyzed key informant interviews with 37 registrars regarding their attitudes and practices in collecting gender identity data. Results: Collection of gender identity is influenced by (1) system-level barriers, (2) discrepancies in source of truth for documentation, and (3) registrars' underlying attitudes and behaviors. Conclusions: Findings demonstrate that person- and system-level barriers can interfere with the accurate and respectful collection of gender identity data, which is critical for tracking and addressing lesbian, gay, bisexual, transgender, and queer health disparities.

Barriers to Care and Root Cause Analysis of LGBTQ+ Patients' Experiences: A Qualitative Study.

BACKGROUND: LGBTQ+ (lesbian, gay, bisexual, transgender, queer/questioning, and others) people face a unique set of barriers to receiving quality healthcare. Very little exists in nursing literature that addresses these barriers. OBJECTIVE: This study aimed to analyze patient experience data to better understand the context of barriers to care that LGBTQ+ patients experience, in addition to institutional responses. METHODS: Documentary analysis was employed to review four LGBTQ+ patient experiences that resulted in formal feedback provided to the Office of Patient Relations. Each case was analyzed for content, process, and outcomes. RESULTS: Through the outlined analysis, the study team found three primary themes and five secondary themes across the four cases. The overarching themes identified through the study's case review include (a) lack of provider knowledge, (b) lack of patient-centered care, and (c) lack of institutional infrastructures associated with the provision of affirming care to LGBTQ+ individuals. DISCUSSION: Findings suggest the need for a multipronged approach when addressing the care of LGBTQ+ communities. A combination of provider-level education and institutional capacity building to treat diverse patient populations is necessary for addressing the issues demonstrated within the data. Moreover, further research is needed to identify unique needs of transgender and nonbinary patients and determine efficacy of institutional efforts to build capacity for caring and studying the health needs of LGBTQ+ communities.

Engaging Community Health Workers and Social Care Staff as Social First Responders during the COVID-19 Crisis.

In this public health practice vignette, we describe an ongoing community and system intervention to identify and address social determinants of health and related needs experienced by ChristianaCare patients and the greater community during the Coronavirus pandemic. This intervention, being conducted by the ChristianaCare Office of Health Equity, in partnership with ChristianaCare's embedded research institute, the Value Institute, and the Community Outreach and Education division of the Helen F. Graham Cancer Center and Research Institute, engages more than 25 community health workers, health Guides, Latinx health promoters and other social care staff as social first responders during the COVID-19 crisis. These experienced front-line social care staff screen patients and community members for social needs; make referrals to agencies and organizations for needed assistance (e.g., food, housing, financial assistance); assess people's understanding of COVID-19 and preventive measures; provide education about COVID-19; and, connect patients and community members to COVID-19 testing and any relevant clinical services. While this ongoing intervention is under evaluation, we share here some preliminary lessons-learned and discuss the critical role that social first responders can play in reducing the growing adverse social and health impacts of COVID-19 across the state of Delaware.

Caring for Our Community: Telehealth Interventions as a Promising Practice for Addressing Population Health Disparities of LGBTQ+ Communities in Health Care Settings.

While the United States has seen social and policy-based progress in the past two decades, the divisive political climate in the United States toward LGBTQ+ individuals highlights the prevalence of homophobia and transphobia that continues to harm and marginalize these communities. Within the context of health care, LGBTQ+ individuals face discrimination and mistreatment, further perpetuating a community narrative of mistrust in the health care system at large. Despite well-documented evidence of population-specific health needs and risks, LGBTQ+ individuals report less utilization of primary care than their heterosexual and cisgender counterparts. Initial studies of LGBTQ+ individuals' engagement in telehealth interventions have largely focused within the realm of mental and behavioral health. Utilizing tenants and results seen in previous studies conducted regarding LGBTQ+ individual engagement with mental and behavioral telehealth interventions, this article explores the potential of utilizing telehealth as an interventional tool for addressing LGBTQ+ health disparities and reduced engagement within a primary care setting. Taking into consideration cost, geographic diversity, and implementation concerns, telehealth targeted toward LGBTQ+ individuals in a primary care setting could prove to be an effective method for reaching more LGBTQ+ individuals and providing them with population-specific, culturally-competent care.