title: Risks, Benefits, and Importance of Collecting Sexual Orientation and Gender Identity Data in Healthcare Settings: A Multi-Method Analysis of Patient and Provider Perspectives.
abstract: Research suggests that LGBT populations experience barriers to healthcare. Organizations such as the Institute of Medicine recommend routine documentation of sexual orientation (SO) and gender identity (GI) in healthcare, to reduce LGBT disparities. We explore patient views regarding the importance of SO/GI collection, and patient and provider views on risks and benefits of routine SO/GI collection in various settings.
  
  
  
  We surveyed LGBT/non-LGBT patients and providers on their views on SO/GI collection. Weighted data were analyzed with descriptive statistics; content analysis was conducted with open-ended responses.
  
  
  
  One-half of the 1516 patients and 60% of 429 providers were female; 64% of patients and 71% of providers were White. Eighty percent of providers felt that collecting SO data would offend patients, whereas only 11% of patients reported that they would be offended. Patients rated it as more important for primary care providers to know the SO of all patients compared with emergency department (ED) providers knowing the SO of all patients (41.3% vs. 31.6%; P < 0.001). Patients commonly perceived individualized care as an SO/GI disclosure benefit, whereas providers perceived patient-provider interaction improvement as the main benefit. Patient comments cited bias/discrimination risk most frequently (49.7%; N = 781), whereas provider comments cited patient discomfort/offense most frequently (54.5%; N = 433).
  
  
  
  Patients see the importance of SO/GI more in primary care than ED settings. However, many LGBT patients seek ED care due to factors including uninsurance; therefore, the ED may represent an initial point of contact for SO/GI collection. Therefore, patient-centered approaches to collecting SO/GI are needed. Patients and providers differed in perceived risks and benefits to routine SO/GI collection. Provider training in LGBT health may address patients' bias/discrimination concerns, and ultimately reduce LGBT health disparities.
authors.affiliation: 1 The Lighthouse Studies at Peer Point, Departments of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health , Baltimore, Maryland.
authors.forename: Allysha C
authors.initials: AC
authors.lastname: Maragh-Bass
authors.affiliation: 2 Center for Surgery and Public Health , Harvard Medical School, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.|3 Department of Surgery, Brigham and Women's Hospital , Boston, Massachusetts.
authors.forename: Maya
authors.initials: M
authors.lastname: Torain
authors.affiliation: 2 Center for Surgery and Public Health , Harvard Medical School, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.|3 Department of Surgery, Brigham and Women's Hospital , Boston, Massachusetts.
authors.forename: Rachel
authors.initials: R
authors.lastname: Adler
authors.affiliation: 2 Center for Surgery and Public Health , Harvard Medical School, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.|3 Department of Surgery, Brigham and Women's Hospital , Boston, Massachusetts.
authors.forename: Eric
authors.initials: E
authors.lastname: Schneider
authors.affiliation: 2 Center for Surgery and Public Health , Harvard Medical School, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.|3 Department of Surgery, Brigham and Women's Hospital , Boston, Massachusetts.
authors.forename: Anju
authors.initials: A
authors.lastname: Ranjit
authors.affiliation: 4 Department of Surgery, Johns Hopkins University School of Medicine , Baltimore, Maryland.
authors.forename: Lisa M
authors.initials: LM
authors.lastname: Kodadek
authors.affiliation: 4 Department of Surgery, Johns Hopkins University School of Medicine , Baltimore, Maryland.
authors.forename: Ryan
authors.initials: R
authors.lastname: Shields
authors.affiliation: 1 The Lighthouse Studies at Peer Point, Departments of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health , Baltimore, Maryland.
authors.forename: Danielle
authors.initials: D
authors.lastname: German
authors.affiliation: 5 Department of General Internal Medicine, Johns Hopkins University School of Medicine , Baltimore, Maryland.|6 Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health , Baltimore, Maryland.
authors.forename: Claire
authors.initials: C
authors.lastname: Snyder
authors.affiliation: 7 Emergency Medicine, Johns Hopkins University School of Medicine , Baltimore, Maryland.
authors.forename: Susan
authors.initials: S
authors.lastname: Peterson
authors.affiliation: 8 Brigham & Women's Hospital, Harvard Medical School , Boston, Massachusetts.
authors.forename: Jeremiah
authors.initials: J
authors.lastname: Schuur
authors.affiliation: 4 Department of Surgery, Johns Hopkins University School of Medicine , Baltimore, Maryland.
authors.forename: Brandyn
authors.initials: B
authors.lastname: Lau
authors.affiliation: 2 Center for Surgery and Public Health , Harvard Medical School, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.|3 Department of Surgery, Brigham and Women's Hospital , Boston, Massachusetts.
authors.forename: Adil H
authors.initials: AH
authors.lastname: Haider
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D004636:Emergency Service, Hospital; D005260:Female; D005783:Gender Identity; D006282:Health Personnel / Q000523:psychology*; D055991:Health Records, Personal / Q000523:psychology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D018802:Patient-Centered Care / Q000379:methods; D036301:Qualitative Research; D015203:Reproducibility of Results; D012725:Sexual Behavior; D000072339:Sexual and Gender Minorities / Q000523:psychology*; D014481:United States
keywords: LGBT; emergency department; health disparities; patient-centered care; qualitative research; quality of care