Moore Scott Emory, Gillani Braveheart, Prince Dana M, Amkraut Ruthy, Broz Jackie, Francis Enrique, Feerasta Gulnar, Harris Phyllis Seven, Mintz Laura Janine
Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH, USA.
Mandel School of Applied Social Sciences, Case Western Reserve University, Cleveland, OH, USA.
J Homosex. 2024 Nov 21:1-18. doi: 10.1080/00918369.2024.2431673.
Health care transitions, movements between providers or settings, can lead to poor outcomes, higher resource utilization, and even higher costs. Health care transitions can be complex experiences for sexual and gender diverse (SGD) individuals, especially when there is a need for ongoing health care (e.g. gender-affirming therapy, depression). Engaging new providers can lead to setbacks in trust requiring self-disclosure SGD-identities all over again. The Transitional Care Model (TCM) supports improvement of outcomes associated with health care transitions; however, it has not been tailored to address the unique needs of SGD populations. A sample of adult SGD patients ( = 17) and SGD health experts ( = 11) from across the US completed a six cycle, electronic, modified Delphi process to adapt the TCM for the SGD population. The iterative process produced a TCM for SGD populations including eight refined and renamed components with SGD-specific descriptions and exemplars. The resulting model, the Sexual and Gender Diverse Healthcare Navigation Model, provides an eight-component adaptive model of transitional care that centers SGD patients and their support systems across complex health care systems. The consensus panel provided descriptions for each of the eight resulting components-identifying three foundational components-the right staffing, awareness of needs and risks, and engaging individuals and their support systems throughout transitions in care. This model stands to support improved health outcomes among SGD through a multi-component, patient centered approach to health care navigation.
医疗保健过渡，即从一个医疗机构或环境转移到另一个，可能导致不良后果、更高的资源利用，甚至更高的成本。对于性取向和性别认同多元（SGD）的个体来说，医疗保健过渡可能是复杂的经历，尤其是在需要持续医疗保健（例如性别肯定疗法、抑郁症治疗）的情况下。接触新的医疗服务提供者可能会导致信任受挫，需要再次披露自己的SGD身份。过渡护理模式（TCM）有助于改善与医疗保健过渡相关的结果；然而，它尚未针对SGD人群的独特需求进行调整。来自美国各地的17名成年SGD患者样本和11名SGD健康专家完成了一个六轮的电子改良德尔菲过程，以使TCM适用于SGD人群。这个迭代过程产生了一个适用于SGD人群的TCM，包括八个经过细化和重新命名的组成部分，并带有针对SGD的描述和示例。由此产生的模型，即性取向和性别认同多元医疗保健导航模型，提供了一个八部分的适应性过渡护理模型，该模型以SGD患者及其支持系统为中心，贯穿复杂的医疗保健系统。共识小组对最终的八个组成部分分别进行了描述，确定了三个基础组成部分——合适的人员配备、对需求和风险的认识，以及在整个护理过渡过程中让个体及其支持系统参与进来。该模型有望通过一种多部分、以患者为中心的医疗保健导航方法来支持改善SGD人群的健康结果。
