Project ECHO LGBT: Making System Change to Address a High-Risk Population

Artist/photographer: Lavinia Solano

June 27, 2017

Kelly Gagnon

Research Assistant

WeitzmanInstitute at Community Health Center, Inc.

Gagnonk@chc1.com

How can you effectively treat a high risk population without knowing which patients make up the population? The answer is: you can’t. 

To treat the complex needs of LGBT patients, it is necessary to remove the veil hiding this population from their health care providers. This removes stigma and increases the availability of treatment options based off of the specific needs of this population.

In collaboration with the Centers for Disease Control (CDC) and the National Association for Community Health Centers (NACHC), Dr. Wanda Montalvo of the Weitzman Institute at Community Health Center, Inc. led an initiative entitled “Transforming Primary Care for LGBT People” to improve the quality of care LGBT patients receive at 10 Federally Qualified Health Centers (FQHCs). 

This initiative took place over the course of a year, beginning in March of 2016. The primary focus of this initiative was the identification of the Sexual Orientation and Gender Identity (SOGI) of patients and the integration of this information into the electronic health record (EHR). Through the documentation of SOGI in the EHR, health care providers can make informed decisions about how to provide much needed care. 

Project ECHO LGBT 

The 10 FQHCs engaged in the initiative were provided access to Project ECHO LGBT and a Practice Improvement Collaborative (PIC) hosted by the Weitzman Institute’s online learning network. Project ECHO LGBT featured expert faculty from the Fenway Institute, who provided didactic presentations and facilitated and addressed case-based questions from providers attending ECHO. Project ECHO LGBT didactics addressed the full scope of relevant clinical topics to improve the knowledge and competency of providers.

• Within one year, the 10 FQHCs engaged in the initiative were able to implement system change and identify the SOGI of 50.8% of their patient population (205,738). 
• Of the 10 FQHCs, nine were able to integrate SOGI into the EHR. 
• Throughout the year, each FQHC was able to improve risk-based screening and STD and HIV screening rates within this population, due to the increased visibility of at risk patients. 

This initiative yielded insight into how the engaged sites were able to make system change within the elaborate environment of an FQHC. The lessons learned across the 10 FQHCs provide an accurate account of the necessary steps and tools needed to unveil and begin population-specific treatment of LGBT patients. 

Culture First, Data Second

While documentation and data are critical to the big picture treatment of this population, the necessary first step is to consider the culture of your staff and patient population. The FQHCs found that alienation of both providers and patients was more likely if system change was disseminated without first considering the culture of staff and patients. 

It Starts at the Top

All FQHCs endorsed that the most important factor in the success of organization-wide system change was buy-in from leadership. Regardless of how important the work was to staff, patients, or the community, it was difficult to make change without the support of key leadership members. These include the CEO, CMO, and departmental heads in key departments like Human Resources, Communications, and Business Intelligence. 

Let’s Get Behavioral (Health, that is). 

Considering the societal stigmatization of LGBT people, it was not surprising to find that many of the case presentations on Project ECHO LGBT surrounded the behavioral health needs of LGBT patients. Whether the patient struggled with suicidal ideation, substance abuse, or sex addiction, it was evident that it’s necessary to treat each patient as a whole person and not only focus on their physical health through screening for STDs and HIV. System change cannot only accommodate physical health, but must address the mental health of patients to reduce incidence of chronic disease and other long-term health conditions that create poor quality of life for the patient.

The efforts of the 10 engaged FQHCs, with the guidance and assistance of the CDC, NACHC, the Weitzman Institute, and the Fenway Institute, cumulated in a critical understanding of how to make high-level system change to improve access and quality of care to an at-risk population. 

For more information on this work, please visit https://www.weitzmaninstitute.org/project-echo. You can also contact Agi Erickson, Director of Project ECHO, at EricksA@chc1.com or (860) 347-6971 ext 3741.

Kelly Gagnon graduated from Hobart and William Smith Colleges in 2013 with   Bachelor of Arts degree in Psychology and French. During her undergraduate career, she conducted research on how to improve the quality of life of adolescent mothers and their children. This inspired her interest in research in sexual health. The needs of these mothers also opened her eyes to the needs of a widely underserved population. Her goal is to continue to work with these underserved populations to improve health disparities. Kelly is currently enrolled in a Master of Public Health program at Southern Connecticut State University. Kelly joined the Weitzman Institute in 2016 to assist with the LGBT ECHO and Pain research projects. She hopes that through working on these projects and others she can gain valuable research experience. After graduating from her Master’s degree program, she plans on continuing her education and pursuing a PhD program.