The TRANS-SAFE Patient Safety Learning Lab: Systems Improvement for Psychosocial Safety in Transgender Care

这个患者安全学习实验室(PSLL)将解决科学中两个主要空白的交集 患者安全：1)心理社会患者伤害/可避免的患者痛苦，以及2)变性人的患者安全 个人。它将利用一个由临床和系统改进专家组成的跨学科团队来 为AHRQ的患者安全使命做出创新和可持续的贡献。它还将回应AHRQ关于 促进卫生公平的卫生服务研究。变性人是AHRQ的优先事项 人口。我们还将通过有针对性地从以下地点招募人员来解决跨性别身份的影响 其他AHRQ优先人群：低收入个人、少数群体和残疾人。 在患者安全的科学和实践中，心理社会伤害在很大程度上被忽视了，尽管有证据表明 它的普遍和随之而来的影响。跨安全PSLL将通过以下方式促进患者安全科学 识别和解决可能是最脆弱的患者造成心理社会伤害的系统性原因 人口--变性人。由于普遍存在的耻辱，许多变性人生活在 他们处于社会的边缘，面临歧视、排斥和暴力。变性人和性别非二元(TGNB) 个人也在医疗保健系统中遭受虐待，导致直接的(心理)伤害和 间接的身体伤害。30%的跨性别者报告称，由于歧视而推迟或不寻求治疗， 这可能会导致诊断延迟和可预防的疾病进展。因此，他们经历了贫穷 健康与“顺性人”(非变性人)相比。这种PSLL将提高患者的安全性 跨性别人口通过3个具体目标：目标1：确定导致可避免的促成因素 变性人患者的痛苦[问题分析]。应用人的因素，改进科学， 风险管理和生物心理技术系统方法，以解决以人为中心的问题 分析确定变性人中可避免的患者痛苦的决定因素，包括问题 比如性别不匹配、不尊重、辱骂和“迷失在体制中”。目标2：共同设计以人为本 预防和减轻变性人中可避免的患者痛苦的解决方案[设计， 发展]。在共同设计和开发的迭代过程中与所有利益攸关方接触， 使用新的和成熟的工具来制定干预措施，以解决以下系统性决定因素 变性人的心理社会伤害。目标3：评估拟议干预措施的有效性 在真实、模拟和临床环境中[实施、评估]。测试干预措施 在目标2中在实际实践环境和模拟环境中设计，以评估有效性、可接受性、 可用性、可实施性和可持续性。创新的传播方法(认证方案 与世界变性人健康专业协会合作)将促进广泛和 可持续的影响。

This patient safety learning laboratory (PSLL) will address the intersection of two major gaps in the science of patient safety: 1) psychosocial patient harm / avoidable patient suffering, and 2) patient safety for transgender individuals. It will leverage an interdisciplinary team of clinical and systems improvement experts to make an innovative, and sustainable contribution to AHRQ’s patient safety mission. It will also address AHRQ’s call for health services research to advance health equity. Transgender individuals are an AHRQ priority population. We will also address intersectional impacts of transgender status by targeted recruitment from additional AHRQ priority populations: low-income individuals, minority groups and people with disabilities. Psychosocial harm has been largely neglected in the science and practice of patient safety, despite evidence of its pervasive and consequential impact. The TRANS-SAFE PSLL will advance patient safety science by identifying and addressing the systemic causes of psychosocial harm in perhaps the most vulnerable patient population–transgender people. Because of widespread stigma, many transgender individuals live on the margins of society, facing discrimination, exclusion, and violence. Transgender and gender non-binary (TGNB) individuals also experience mistreatment in the healthcare system, leading to direct (psychosocial) harm and indirect physical harm. >30% of transgender individuals report delaying or not seeking care due to discrimination, which may lead to diagnostic delays and preventable disease progression. As a result, they experience poor health compared to “cisgender” (non-transgender) people. This PSLL will improve patient safety for the transgender population through 3 specific aims: Aim 1: Identify the contributing factors leading to avoidable patient suffering in transgender individuals [Problem analysis]. Apply human factors, improvement science, risk management, and biopsychosociotechnical systems approaches to conduct a human-centered problem analysis that identifies determinants of avoidable patient suffering in transgender individuals, including issues such as misgendering, disrespect, abuse, and “getting lost in the system.” Aim 2: Co-design human-centered solutions to prevent and mitigate avoidable patient suffering in transgender individuals [Design, development]. Engage with the full range of stakeholders in an iterative process of co-design and development, using both new and proven tools to produce interventions that address the systemic determinants of psychosocial harm in transgender individuals. Aim 3: Evaluate the effectiveness of proposed interventions in real and simulated and clinical environments [Implementation, evaluation]. Test the interventions designed in Aim 2 in both actual practice settings and in simulation to evaluate effectiveness, acceptability, usability, implementability, and sustainability. An innovative dissemination approach (a certification program in partnership with the World Professional Association for Transgender Health) will facilitate widespread and sustainable impact.