Do Ask, Do Tell: High Levels of Acceptability by Patients of Routine Collection of Sexual Orientation and Gender Identity Data in Four Diverse American Community Health Centers

Abstract

BackgroundThe Institute of Medicine and The Joint Commission have recommended asking sexual orientation and gender identity (SOGI) questions in clinical settings and including such data in Electronic Health Records (EHRs). This is increasingly viewed as a critical step toward systematically documenting and addressing health disparities affecting lesbian, gay, bisexual, and transgender (LGBT) people. The U.S. government is currently considering whether to include SOGI data collection in the Stage 3 guidelines for the incentive program promoting meaningful use of EHR. However, some have questioned whether acceptable standard measures to collect SOGI data in clinical settings exist.MethodsIn order to better understand how a diverse group of patients would respond if SOGI questions were asked in primary care settings, 301 randomly selected patients receiving primary care at four health centers across the U.S. were asked SOGI questions and then asked follow-up questions. This sample was mainly heterosexual, racially diverse, and geographically and regionally broad.ResultsThere was a strong consensus among patients surveyed about the importance of asking SOGI questions. Most of the LGBT respondents thought that the questions presented on the survey allowed them to accurately document their SOGI. Most respondents—heterosexual and LGBT—answered the questions, and said that they would answer such questions in the future. While there were some age-related differences, respondents of all ages overwhelmingly expressed support for asking SOGI questions and understood the importance of providers' knowing their patients' SOGI.ConclusionsGiven current deliberations within national health care regulatory bodies and the government's increased attention to LGBT health disparities, the finding that patients can and will answer SOGI questions has important implications for public policy. This study provides evidence that integrating SOGI data collection into the meaningful use requirements is both acceptable to diverse samples of patients, including heterosexuals, and feasible.

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“…The capacity of the electronic health record to document gender identity should be analyzed and updated, and registration and appointment scheduling procedures revised to include questions inclusive of all gender identities. [35][36][37] Staff members who answer the phone should be trained to make no assumptions about gender identity from the timbre of a person's voice, the gender marker on their medical record, or their legal name.…”

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“…Recent research suggests that SGM individuals are more likely to disclose SOGI information if asked and are willing to disclose SOGI information if they know why they are being asked. 20,21 Several commentaries and opinion-based articles suggest that the collection of SOGI data can improve patient outcomes and patient-physician communication. [22][23][24] There was a misperception identified in this study, which has also been identified in previous research, that sexual orientation is only relevant if the issue at hand is directly related to sexuality.…”

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“…Although finding inclusive and clinically useful language to denote patient SO/GI data in the EHR can be challenging, research demonstrates that heterosexual and LGBT individuals are overwhelmingly supportive of this information collection when respectfully asked and provided reasoning to why this information is clinically relevant [33]. Additionally, researchers with the Community Health Applied Research Network have determined that asking questions pertaining to SO/GI is an appropriate standard for health centers that are diverse in terms of geography, gender, region, race/ethnicity, sexual orientation and age [34].…”