Structural competency in emergency medicine services for transgender and gender non-conforming patients

Willging, Cathleen E.; Gunderson, Lara; Shattuck, Daniel; Sturm, Robert; Lawyer, Adrien; Crandall, Cameron

doi:10.1016/j.socscimed.2018.12.031

Cited by 41 publications

(43 citation statements)

References 37 publications

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“…First, recognize that the statistics derived from EHRs do not reflect a “transgender population.” Descriptive statistics, inferences, or associations drawn from these kinds of data require more specificity. Instead of “an analysis of the mental health among trans women,” one might instead say, “resilience scores in a sample of nonbinary, young adults assigned male at birth taking exogenous feminizing hormones” (Donald et al, 2017; Labuski & Keo-Meier, 2015; Willging et al, 2019). This kind of specificity in research will also serve clinicians and patients well in reducing harmful assumptions about patients.…”

Section: Discussionmentioning

confidence: 99%

“…Though researchers may account for perceived stigma or discrimination, poor health outcomes are associated with race, class, and gender. In clinical settings, this knowledge can serve to essentialize inequality and health disparities rather than scrutinize relational processes such as structural competence or structural violence (Cruz, 2020; Spade, 2011; Willging et al, 2019). That is, the framework creates visibility through stereotyping whereby health disparities get statistically tied to individual traits deemed immutable rather than to structural conditions.…”

Section: Introductionmentioning

confidence: 99%

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Stakeholder Experiences With Gender Identity Data Capture in Electronic Health Records: Implementation Effectiveness and a Visibility Paradox

Thompson

2020

Health Educ Behav

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Background Advocates have endorsed transgender visibility via gender identity (GI) data capture with the advent of the Affordable Care Act and electronic health record (EHR) requirements. Visibility in data in order to enumerate a population contrasts with ways in which other LGBT and public health scholars have deployed these concepts. Aims The article aims to assess the effectiveness of GI data capture in EHRs and implications for trans health care quality improvements and research. Method Semistructured interviews were conducted with 27 stakeholders from prominent gender-affirming care providers across the United States. A range of informants shared their experiences with GI data capture. Interviews were coded, themes were identified, and the extended case method was used to contextualize data in relation to key concepts. Results Data capture is effective for increasing patient counts and making quality improvements but limited in terms of enhancing gender-affirming care depending on provider size, type, and competencies. Many challenges were highlighted regarding use of GI data for research, sharing GI data across systems, as well the ways data capture erases the dynamism of GI. These issues create conditions for limited kinds of disclosure, capture of particular categories, and care and treatment barriers. Discussion Stakeholders exposed a visibility paradox emerging from GI data capture. While data fields are created to increase the visibility of trans persons in medical settings and in health research, they work to increase the visibility of some while reducing the visibility of other gender diverse persons, including trans, nonbinary, and cisgender. Conclusion New approaches are needed to explore implications of GI data standardization and the logics of health care in the face of gender expansiveness.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Stakeholder Experiences With Gender Identity Data Capture in Electronic Health Records: Implementation Effectiveness and a Visibility Paradox

Thompson

2020

Health Educ Behav

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“…These structural changes include initiatives within health care contexts, such as adopting gender‐inclusive record‐keeping systems, policies and procedures. For example, decisions on the gendered space for patients often based on staff discretion are frequently taken inappropriately for trans patients (Willging et al., 2019). In this sense, these structural‐level changes could advocate for neutral or safe spaces, which guarantee anyone's privacy and options against the current highly gendered spaces (Kellett & Fitton, 2017; Thornton, 2018).…”

Section: Discussionmentioning

confidence: 99%

Improving the care management of trans patients: Focus groups of nursing students’ perceptions

et al. 2020

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“…[1,125] This structural incompetency translates into significant pitfalls in SOGI data collection. [126][127][128][129] SOGI data collection often begins with intake forms. Institutions and providers do not always understand how to ask for one's gender identity.…”

Section: From the Clinical Perspectivementioning

confidence: 99%

Transgender Data Collection in the Electronic Health Record (EHR): Current Concepts and Issues

Kronk¹,

Everhart²,

Ashley³

et al. 2021

Preprint

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There are over one million transgender people living in the United States and 33% report negative experiences with a healthcare provider, many of which are connected to data representation in electronic health records (EHRs). We present recommendations and common pitfalls involving sex- and gender-related data collection in EHRs. Our recommendations leverage the needs of patients, medical providers, and researchers to optimize both individual patient experiences and the efficacy and reproducibility of EHR population-based studies. We also briefly discuss adequate additions to the EHR considering name and pronoun usage. We add the disclaimer that these questions are more complex than commonly assumed. We conclude that collaborations between local transgender and gender-diverse persons and medical providers as well as open inclusion of transgender and gender-diverse individuals on terminology and standards boards is crucial to shifting the paradigm in transgender and gender-diverse health.

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Structural competency in emergency medicine services for transgender and gender non-conforming patients

Cited by 41 publications

References 37 publications

Stakeholder Experiences With Gender Identity Data Capture in Electronic Health Records: Implementation Effectiveness and a Visibility Paradox

Stakeholder Experiences With Gender Identity Data Capture in Electronic Health Records: Implementation Effectiveness and a Visibility Paradox

Improving the care management of trans patients: Focus groups of nursing students’ perceptions

Transgender Data Collection in the Electronic Health Record (EHR): Current Concepts and Issues

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