Advance Care Planning (ACP) among Sexual and Gender Minority Individuals and Their Caregivers

性和性别少数人(SGM)面临歧视、耻辱和健康 差距。高级护理计划(ACP)旨在确保人们获得 当他们患上重病时，与他们的目标、偏好和价值观保持一致。我们在中国的工作 Parent R01将研究采用ACP的趋势、障碍和促进者及其影响 在照顾方面。然而，在SGM社区对ACP的研究还很少。这是混合的- 方法补充建议将建立在我们现有研究的基础上，以更好地了解机场核心计划 在SGM成年人和他们的照顾者中。 目标1：了解与高级护理计划(ACP)讨论相关的因素 在使用索赔数据的变性人或性别非二元联邦医疗保险受益人中。 使用按服务收费的联邦医疗保险索赔，我们将使用以前经过验证的诊断代码 旨在识别变性人或性别非二元受益人的算法，以衡量 计费的ACP访问率。我们将在2016年内检查该代码的吸收和使用情况- 2018年，与其他高需求人群相比。 目标2：了解自我认同面临的需求、亲身经历和挑战 非加太周围的性和性别少数(SGM)成年人。 利用一项全国性的民意调查，我们将SGM成年人与其他受访者在 有限数量的ACP问题，包括任命医疗代理的经验，以及 完成先行指令(ADS)。将重新联系SGM受访者中的一部分 后续半结构化访谈，以更深入地探讨高级护理的定性 与临床提供者进行规划以及家庭/合作伙伴/照顾者、法律近亲的角色 身份以及对偏见和/或歧视的看法。 确定SGM成年人的ACP比率和参与度的模式将有助于了解 以人为本的干预措施，促进弱势群体或 服务不足的人群。这个项目将解决一个关键的证据缺口 促进照顾老年SGM成年人的科学研究。

Sexual and gender minority individuals (SGM) face discrimination, stigma, and health disparities. Advance Care Planning (ACP) aims to ensure people receive medical care that is consistent with their goals, preferences, and values as they become seriously ill. Our work in the parent R01 is to study the trends, barriers, and facilitators to the uptake of ACP and its impact on care. However, there exists scant research on ACP in the SGM community. This mixed- methods supplemental proposal will build on our existing research to better understand ACP among SGM adults and their caregivers. Aim 1: To understand factors associated with Advance Care Planning (ACP) discussions among transgender or gender non-binary Medicare beneficiaries using claims data. Using Fee-for-Service Medicare claims, we will utilize a previously validated diagnosis code algorithm designed to identify transgender or gender non-binary beneficiaries to measure the rate of billed ACP visits. We will examine uptake and use of this code during the years 2016- 2018, compared with other high needs populations. Aim 2: To understand the needs, lived experiences, and challenges facing self-identified sexual and gender minority (SGM) adults around ACP. Using a national polling survey, we will compare SGM adults with other respondents on a limited number of ACP issues, including experience appointing healthcare proxies, and completion of Advance Directives (ADs). A subset of SGM respondents will be re-contacted for follow-up semi-structured interviews for a more in-depth qualitative exploration of advance care planning with clinical providers and the role of family/partners/caregivers, legal next of kin status, and perceptions of bias and/or discrimination. Identifying patterns around ACP rates and engagement among SGM adults will help inform person-centered interventions to facilitate high quality ACP discussions among vulnerable or underserved populations. This project will address a critical evidence gap in conducting research to advance the science of caring for aging SGM adults.