Digital Safety Net Expansion of Sexual/Gender Minority Focused (LGBTQIA+) Health Centers

From the 2023 HVPA National Conference

Thomas McGrath, Bachelor of Science (Hackensack Meridian School of Medicine), Sarah Isaac, Bachelor of Arts, Antonia F. Oladipo MD, MSCI, Florian P. Thomas MD, PhD, Tovah Tripp MD, Brian Amorello PhD, Barbara Graham MS, Joshua Josephs MD, PhD

As the needs of the modern patient further rely on interprofessional collaboration, so do the nuanced needs of the sexual/gender minoritized (LGBTQIA+) patient. Most healthcare systems do not fully appreciate the tailored approach needed when treating LGBTQIA+ patients, including language preference and medical testing. Thus, LGBTQIA+ patients are at increased risk for care avoidance, further isolating an already vulnerable group. Some healthcare organizations have addressed this care gap by creating designated LGBTQIA+ centers. A physical center, however, only benefits those who live nearby with reliable, accessible transportation.

The Hackensack Meridian Health (HMH) network features current providers using the “find a doctor” search tool. This allows patients to filter providers by location, gender, language, etc. To ensure access to affirming care across medical teams, a label was created to identify providers from various professions who have a special interest in working with LGBTQIA+ patients. This project aims to develop an additional filter for providers’ profiles, allowing them to be identified as someone who is knowledgeable to work with this unique population. It empowers LGBTQIA+ patients to have a greater sense of control, collaboration, and continuity with their care. This initiative will expand the safety net of LGBTQIA+ health centers beyond the physical walls of a clinic through improved geographic access to care.

To improve access to affirming healthcare from LGBTQIA+ enthusiastic providers in a large, interdisciplinary healthcare system by adapting existing digital systems.

Within the HMH network in New Jersey, a network-wide survey was distributed to all providers between October 1, 2021 to November 1, 2021. Providers were asked to self-identify as an individual who “provides LGBTQIA+ centered care.”

In the one month that the survey circulated the HMH network, eighty-eight providers (n=88) from various specialties responded “yes” to wishing to be labeled as a provider who is enthusiastic about working with LGBTQIA+ patients. About 60% were physicians, 15% advanced practice providers, 8% psychologists, and 9% social workers.

While eighty-eight is a seemingly modest number of responses, any physical clinic with an interdisciplinary staff of that size would certainly be a force. When devising solutions for improving access to LGBTQIA+ affirming care, this project excels by alleviating the geographic hurdle that physical centers inadvertently pose. While a brick and mortar health center is undoubtedly beneficial to local patients, it will always be restricted to a finite area. Patients who live outside the reach of these health centers deserve the same level of access to affirming healthcare. This project allows any patient with internet access to identify nearby LGBTQIA+ sensitive and affirming providers within the HMH network.

Clinical Implications:
This project will allow all patients within the HMH network to identify providers from a multitude of professions who are sensitive to the nuanced needs of the LGBTQIA+ community, improving collaboration and continuity of care. It reduces the risk of healthcare avoidance, which decreases the possibility of requiring high acuity, high cost care for accumulating preventable issues. This project may serve as a potential solution for healthcare networks seeking to improve LGBTQIA+ healthcare access where constructing a physical center may not be feasible.

What are academic medical centers across the country doing to improve healthcare value?

Value improvement guides: Published reviews in JAMA Internal Medicine coauthored by experienced faculty from multiple leading medical centers, with safety outcomes data and an implementation blue print.

Review article detailing 25 labs to refine for high value quality improvement | July 2020

MAVEN campaign: Free 4 year high value care curriculum online.

Join the Alliance! Membership is free with institutional approval and commitment to improving value in your medical center.

Learn more about HVPA on Health Affairs Blog