Do Ask, Do Tell


Quality Improvement Staff

The ultimate purpose of collecting information about sexual orientation and gender identity in clinical settings is to improve the quality of care for all patients. SO/GI data collection offers numerous opportunities to integrate the improvement of LGBT health into institutional and national quality improvement standards, policies, and practices.

Common national frameworks for quality improvement include the six aims of safety, timeliness, effectiveness, efficiency, patient-centeredness, and equity set forth by the Institute of Medicine (IOM), (15) and the “triple aim” of improved patient experiences of care, improved population health outcomes, and reduced costs developed by the Institute for Healthcare Improvement., (16, 17)

Within the IOM framework, for instance, the aim of patient-centeredness is particularly relevant to both overall LGBT population health and the experiences of individual LGBT patients. The Joint Commission published a field guide in 2011 that calls for routine SO/GI data collection in clinical settings as part of improving effective communication, cultural competence, and patient- and family-centered care for LGBT patients and families. (18) And in 2013 the Patient-Centered Outcomes Research Institute (PCORI) made its first award investigating improvement of patient-centered outcomes for LGBT patients by supporting a multi-year investigation of SO/GI data collection in the Emergency Department of the Johns Hopkins Hospital. (19)

Further, the National Committee on Quality Assurance released new standards in 2014 for patient-centered medical homes (PCMH). Echoing the updated HHS Culturally and Linguistically Appropriate Services (CLAS) Standards, (20) which now include sexual orientation and gender identity, these standards direct PCMHs to evaluate the diversity of their patient populations as part of a comprehensive health assessment, defining “diversity” as “a meaningful characteristic of comparison … that accurately identifies individuals within a non-dominant social system who are underserved. These characteristics of a group may include, but are not limited to, race, ethnicity, gender identity, sexual orientation, and disability.” (21)

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