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Research ArticleOriginal Research

Transforming Primary Care for Lesbian, Gay, Bisexual, and Transgender People: A Collaborative Quality Improvement Initiative

Bruce W. Furness, Hilary Goldhammer, Wanda Montalvo, Kelly Gagnon, Lauren Bifulco, Daniel Lentine and Daren Anderson
The Annals of Family Medicine July 2020, 18 (4) 292-302; DOI: https://doi.org/10.1370/afm.2542
Bruce W. Furness
1Division of Sexually Transmitted Disease Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
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  • For correspondence: bff0@cdc.gov
Hilary Goldhammer
2The Fenway Institute, Fenway Health, Boston, Massachusetts
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Wanda Montalvo
3Jonas Nursing & Veterans Healthcare, Columbia University, New York, New York
4Weitzman Institute, Community Health Center, Inc, Middletown, Connecticut
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Kelly Gagnon
4Weitzman Institute, Community Health Center, Inc, Middletown, Connecticut
5University of Pittsburgh, Graduate School of Public Health, Pittsburgh, Pennsylvania
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Lauren Bifulco
4Weitzman Institute, Community Health Center, Inc, Middletown, Connecticut
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Daniel Lentine
1Division of Sexually Transmitted Disease Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
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Daren Anderson
4Weitzman Institute, Community Health Center, Inc, Middletown, Connecticut
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Abstract

PURPOSE Lesbian, gay, bisexual, and transgender (LGBT) people experience multiple disparities in access to care and health outcomes. We developed a quality improvement initiative, Transforming Primary Care for LGBT People, to enhance the capacity of federally qualified health centers (FQHCs) to provide culturally affirming care for this population.

METHODS The 1-year intervention blended the models of Practice Improvement Collaboratives and Project ECHO (Extension for Community Health Outcomes) to facilitate learning and translate knowledge into action. FQHC teams received coaching in creating LGBT-inclusive environments, collecting sexual orientation and gender identity (SOGI) data, taking risk-based sexual histories, and screening LGBT people for syphilis, chlamydia and gonorrhea, and HIV. We used a preintervention-postintervention evaluation design.

RESULTS We selected 10 FQHCs serving 441,387 patients in 123 clinical sites in 9 states. The intervention spread from 10 clinicians in 10 clinical sites to 431 clinicians in 79 clinical sites. FQHCs reported increases in culturally affirming practices, including collecting patient pronoun information (42.9% increase) and identifying LGBT patient liaisons (300.0% increase). Postintervention, among 9 FQHCs reporting SOGI data from electronic health records, SOGI documentation increased from 13.5% to 50.8% of patients (276.3% increase). Among 8 FQHCs reporting number of LGBT patients, screening of LGBT patients increased from 22.3% (95% CI, 4.9%-40.0%) to 34.6% (95% CI, 19.4%-48.6%) for syphilis (86.5% increase); from 25.3% (95% CI, 7.6%-43.1%) to 44.1% (95% CI, 30.2%-58.1%) for chlamydia and gonorrhea (109.0% increase); and from 14.8% (95% CI, 3.2%-26.5%) to 30.5% (95% CI, 26.7%-34.3%) for HIV (132.4% increase).

CONCLUSIONS FQHCs participating in this initiative reported improved capacity to provide culturally affirming care and targeted screening for LGBT patients.

Key words
  • sexual orientation
  • gender identity
  • sexual and gender minorities
  • sexually transmitted disease
  • cultural competency
  • intervention
  • quality improvement
  • Project ECHO
  • Practice Improvement Collaborative
  • vulnerable populations
  • healthcare disparities
  • primary health care
  • practice-based research
  • Received for publication June 17, 2019.
  • Revision received October 31, 2019.
  • Accepted for publication November 11, 2019.
  • © 2020 Annals of Family Medicine, Inc.
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The Annals of Family Medicine: 18 (4)
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July/August 2020
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Transforming Primary Care for Lesbian, Gay, Bisexual, and Transgender People: A Collaborative Quality Improvement Initiative
Bruce W. Furness, Hilary Goldhammer, Wanda Montalvo, Kelly Gagnon, Lauren Bifulco, Daniel Lentine, Daren Anderson
The Annals of Family Medicine Jul 2020, 18 (4) 292-302; DOI: 10.1370/afm.2542

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Transforming Primary Care for Lesbian, Gay, Bisexual, and Transgender People: A Collaborative Quality Improvement Initiative
Bruce W. Furness, Hilary Goldhammer, Wanda Montalvo, Kelly Gagnon, Lauren Bifulco, Daniel Lentine, Daren Anderson
The Annals of Family Medicine Jul 2020, 18 (4) 292-302; DOI: 10.1370/afm.2542
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  • Domains of illness & health:
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Keywords

  • sexual orientation
  • gender identity
  • sexual and gender minorities
  • sexually transmitted disease
  • cultural competency
  • intervention
  • quality improvement
  • Project ECHO
  • Practice Improvement Collaborative
  • vulnerable populations
  • healthcare disparities
  • primary health care
  • practice-based research

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