Sexual and Gender Diverse Healthcare Navigation Model: A Community-Participatory Delphi Adaptation of the Transitional Care Model for Sexual and Gender Diverse Individuals.

Abstract

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 (n = 17) and SGD health experts (n = 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.