Guss, C. E., Eiduson, R., Khan, A., Dumont, O., Forman, S. F., & Gordon, A. R. (2020). “It'd Be Great to Have the Options There”: A Mixed-Methods Study of Gender Identity Questions on Clinic Forms in a Primary Care Setting. Journal of Adolescent Health, 67(4), 590-596.
Intervention Components (click on component to see a list of all articles that use that intervention): Quality Improvement
Intervention Description: The specific intervention involves the addition of gender-related questions to clinic intake forms in a primary care setting. The intervention aligns with a discernible strategy aimed at improving healthcare for transgender youth by creating a more inclusive and supportive environment. The study does not analyze a multicomponent intervention; rather, it focuses on the impact of adding gender-related questions to intake forms on documentation in the electronic health record and patient experiences.
Intervention Results: In interviews, the new questions were acceptable and interpretable to adolescents of diverse gender identities. Participants described the questions as beneficial to all patients and perceived them as an indicator of a welcoming clinic environment. The retrospective chart review found that provider documentation of gender identity in the EHR significantly increased after the form change from 51.3% to 66.3% (p < .0001).
Conclusion: This intervention was acceptable to adolescents and associated with a significant increase in EHR documentation. Future studies should investigate how the form change may have facilitated discussion about gender and health and implications for provider training and support.
Study Design: The study design is a mixed-methods approach that includes both qualitative and quantitative components. The study used a plan-do-study-act (PDSA) approach to quality improvement . The first phase of the study was qualitative and involved cognitive interviews with 21 adolescents to examine gender-related questions and assess their acceptability and interpretability . The second phase was a retrospective chart review of patients who came to the clinic for a physical examination visit three months before and after the form change to examine the differences in electronic health record documentation of gender identity . Descriptive analyses were used to explore potential differences in gender documentation by patient demographics and provider type . Finally, qualitative interviews were conducted to identify key themes related to the acceptability and benefits of gender questions on intake forms, as well as concerns related to confidentiality and privacy . The mixed-methods approach allowed the study to evaluate the impact of the intervention on both documentation practices and patient experiences in the primary care setting.
Setting: The study was conducted in an urban adolescent/young adult medicine primary care clinic . This setting allowed for the evaluation of the impact of gender-related questions on clinic forms in a real-world healthcare environment.
Population of Focus: The target audience of the study is healthcare providers and administrators in primary care settings who are interested in improving the collection of gender identity information and documentation practices in electronic health records. The study also provides insights for researchers and policymakers interested in understanding the experiences and perspectives of adolescents and young adults related to gender identity questions on intake forms.
Sample Size: The study involved 21 adolescents who participated in cognitive interviews . The retrospective chart review included 1,442 patients who came to the clinic for a physical examination visit three months before and after the form change
Age Range: The study included participants aged 13 to 25 years
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