Rush University Medical Center, Chicago, IL, USA.
Health Educ Behav. 2021 Feb;48(1):93-101. doi: 10.1177/1090198120963102. Epub 2020 Oct 16.
Advocates have endorsed transgender visibility via gender identity (GI) data capture with the advent of the Affordable Care Act and electronic health record (EHR) requirements. Visibility in data in order to enumerate a population contrasts with ways in which other LGBT and public health scholars have deployed these concepts.
The article aims to assess the effectiveness of GI data capture in EHRs and implications for trans health care quality improvements and research.
Semistructured interviews were conducted with 27 stakeholders from prominent gender-affirming care providers across the United States. A range of informants shared their experiences with GI data capture. Interviews were coded, themes were identified, and the extended case method was used to contextualize data in relation to key concepts.
Data capture is effective for increasing patient counts and making quality improvements but limited in terms of enhancing gender-affirming care depending on provider size, type, and competencies. Many challenges were highlighted regarding use of GI data for research, sharing GI data across systems, as well the ways data capture erases the dynamism of GI. These issues create conditions for limited kinds of disclosure, capture of particular categories, and care and treatment barriers.
Stakeholders exposed a visibility paradox emerging from GI data capture. While data fields are created to increase the visibility of trans persons in medical settings and in health research, they work to increase the visibility of some while reducing the visibility of other gender diverse persons, including trans, nonbinary, and cisgender.
New approaches are needed to explore implications of GI data standardization and the logics of health care in the face of gender expansiveness.
随着平价医疗法案和电子健康记录 (EHR) 要求的出现，倡导者通过性别认同 (GI) 数据采集来支持跨性别者的可见性。数据中的可见性与其他 LGBT 和公共卫生学者部署这些概念的方式形成对比。
本文旨在评估 EHR 中 GI 数据采集的有效性，以及对跨性别者医疗质量改进和研究的影响。
对来自美国知名性别认同护理提供者的 27 名利益相关者进行了半结构化访谈。一系列消息人士分享了他们在 GI 数据采集方面的经验。对访谈进行了编码，确定了主题，并使用扩展案例方法将数据与关键概念联系起来进行背景化。
数据采集对于增加患者数量和提高质量改进是有效的，但在增强性别认同护理方面受到限制，具体取决于提供者的规模、类型和能力。许多人强调了 GI 数据在研究、跨系统共享 GI 数据以及数据采集如何抹去 GI 动态性方面的使用面临的挑战。这些问题为有限类型的披露、特定类别的捕获以及护理和治疗障碍创造了条件。
利益相关者揭示了 GI 数据采集带来的可见性悖论。虽然数据字段的创建是为了增加医疗环境和健康研究中跨性别人士的可见性，但它们的作用是增加某些人的可见性，同时减少其他性别多样化人士的可见性，包括跨性别者、非二元性别者和顺性别者。
需要探索 GI 数据标准化和医疗保健逻辑在性别扩展方面的影响，需要采取新的方法。
