Exploring Quality Measures for the Care of Transgender Persons

背景：变性人占美国人口的0.6%。为数不多的 以跨性别者所接受的护理为特征的研究使用了相对较小的和非 有代表性的样品。有必要更多地了解跨性别者目前接受的护理，因为 这是今后改善这种护理的基础。 方法：我们将使用一个包含约1.6亿人的数据库，该数据库具有广泛的代表性 在美国有商业保险的人。在我们的试点分析中，我们确定了9632名跨性别者 该数据库仅基于性别焦虑症的诊断代码。我们的项目将有三个目标。第一, 我们将使用更全面的方法来识别数据集中的跨性别者，包括其他 诊断代码、程序代码、处方填写和性别变量中的不一致。第二, 在确定了跨性别者的群体后，我们将描述他们所接受的护理的特征。我们已经确定了 跨性护理的四个重要的临床实践指南。使用这些指导方针，我们将确定重要的 变性人护理的一些方面，可以使用大型数据库来描述。举个例子， 我们将确定接受变性人激素治疗的患者实验室监测的充分性。 我们已经确定了至少14个需要研究的护理方面。在最终确定我们的分析清单时，以及 考虑到我们将如何分析它们，我们将得到一个临床专家小组的建议。对于每个分析， 我们将定义一个分母或一组有资格接受该护理元素的患者，以及一个分子 收到它的分母的子集。我们将计算每名患者接受治疗的比例 护理要素，并检查亚组之间的差异(例如，男性与女性的性别认同、年龄、种族)。 第三，我们将召集一个由七名跨性护理临床专家以及三名跨性患者组成的小组。使用我们的 结果，这个技术专家小组(TEP)将帮助我们就哪些分析可能 适合作为制定跨性患者护理质量指标的基础。TEP成员将是 被要求对潜在质量衡量标准的四个方面发表评论：1)重要性；2)可靠性和效度；3) 易懂；4)收集和计算的可行性。 预期影响：这项研究将是描述向TRANS提供的护理的最大规模的研究 到目前为止，这一结果将推广到美国商业保险个人人口。 我们开发的在大型自动化数据库中识别跨性别者的方法将作为 我们团队和其他人未来的研究。除了为医疗服务质量提供基线之外 今天的交易者，我们的结果和我们TEP的投入将为未来的发展提供基础 变性护理的质量措施。这种质量措施的存在有可能促进质量 随着时间的推移不断改进。

Background: Transgender adults (“trans persons”) comprise 0.6% of the United States population. The few studies that have characterized the care received by trans persons have used relatively small and non- representative samples. There is a need to know more about the care that trans persons currently receive, as a basis for improving this care in the future. Approach: We will use a database containing approximately 160 million people, which is broadly representative of commercially insured people in the United States. In our pilot analyses, we identified 9,632 trans persons in this database, based solely upon diagnosis codes for gender dysphoria. Our project will have three aims. First, we will use a more comprehensive approach to identify trans persons in the dataset, including additional diagnosis codes, procedure codes, prescription fills, and inconsistencies in the gender variable. Second, having identified a population of trans persons, we will characterize the care they receive. We have identified four prominent clinical practice guidelines for trans care. Using these guidelines, we will identify important aspects of transgender care that are amenable to being characterized using a large database. As an example, we will characterize the adequacy of laboratory monitoring in patients receiving transgender hormone therapy. We have already identified at least fourteen aspects of care to study. In finalizing our list of analyses, and operationalizing how we will analyze them, we will be advised by a panel of clinical experts. For each analysis, we will define a denominator, or a group of patients eligible to receive that care element, and a numerator, a subset of the denominator who did receive it. We will calculate the proportion of patients who received each care element, and examine differences between subgroups (e.g., male vs. female gender identity, age, race). Third, we will convene a panel of seven clinical experts in trans care, as well as three trans patients. Using our results, this technical expert panel (TEP) will help advise us regarding which analyses would be potentially suitable to serve as a basis for developing quality of care metrics for trans patients. TEP members will be asked to comment on four aspects of potential quality measures: 1) importance; 2) reliability and validity; 3) ease of understanding; and 4) feasibility of collection and calculation. Anticipated Impacts: This study will constitute the largest study to characterize the care delivered to trans persons to date, and the results will be generalizable to the US population of commercially insured individuals. The methods we develop to identify trans persons in a large, automated database will serve as a basis for future studies by our group and by others. In addition to providing a baseline for the quality of care delivered to trans persons today, our results and the input from our TEP will provide a basis for the future development of quality measures for trans care. The existence of such quality measures has the potential to facilitate quality improvement over time.