A Quality Improvement Approach to Enhance LGBTQ+ Inclusivity in Pediatric Primary Care.

Area of Science:

• Pediatric Healthcare Quality Improvement
• LGBTQ+ Health Equity
• Clinical Documentation Best Practices

Background:

• Lesbian, gay, bisexual, transgender, and queer (LGBTQ+) teens face health disparities and reduced healthcare utilization.
• Medical organizations advocate for improved care through staff training and routine inquiry of sexual orientation, gender identity (SO/GI), and pronouns.
• Confidential SO/GI and pronoun collection methods in pediatrics remain underexplored.

Purpose of the Study:

• To implement and assess a quality improvement project for confidential SO/GI and pronoun documentation in adolescent acute care.
• To achieve documentation of SO/GI and pronouns in at least 90% of teen acute care visits.
• To enhance the preparedness of healthcare staff and clinicians in providing affirming care to LGBTQ+ youth.

Main Methods:

• A quality improvement team conducted staff and clinician training on LGBTQ+ affirming care.
• Implemented welcoming visual cues and offered pronoun/rainbow pins to staff.
• Utilized Plan-Do-Study-Act cycles to develop routine and private methods for collecting SO/GI and pronouns.
• Conducted weekly chart reviews to measure documentation rates and surveys to assess staff preparedness.

Main Results:

• Documentation of SO/GI and pronouns increased from 0% at baseline to 70% after six months, reaching 90% during a 20-week sustainment phase.
• The proportion of staff and clinicians feeling prepared to care for lesbian, gay, and bisexual patients increased from 53% to 68%.
• Preparedness to care for transgender patients significantly increased among staff and clinicians, from 30% to 57% (P = .002).

Conclusions:

• Quality improvement methodologies can establish confidential and sustainable protocols for collecting SO/GI and pronouns from adolescent patients.
• Appropriate documentation enables clinicians to address patients correctly and tailor care to their specific needs.
• This approach supports improved health outcomes and equitable care for LGBTQ+ youth in pediatric settings.