No abstract

Background The 21st Century Cures Act and the OpenNotes movement have brought patients immediate access to their electronic health records (EHRs). The experiences of marginalized people, including transgender people, accessing and reviewing their EHRs could inform documentation guidelines to improve patient-clinician rapport and reduce harm. Objective To investigate the experiences of transgender people reviewing EHRs. Design Qualitative study using community-engaged research and an interpretive description methodology. Participants were recruited via social media, snowball sampling was employed, and purposive sampling was used to ensure diversity in terms of age, race/ethnicity, and other factors. In focus groups, participants were asked to discuss their experiences reviewing their EHRs and, for those participants who were clinicians, their experiences reviewing other clinicians’ documentation. Participants Thirty transgender adults aged 20 to 67 years, including 10 clinicians. Approach: Digital audio-recordings of focus groups were transcribed verbatim. Content was analyzed to identify emerging essential elements and analysis was continued until no new themes emerged (i.e., saturation). Key Results Four themes were noted. (1) Using the wrong name, pronoun, or gender marker for patients is common in the EHR, erodes trust, and causes trauma. (2) Various aspects of clinicians’ notes contradict, blame, or stigmatize patients, across multiple axes of oppression. (3) Limitations of EHR capabilities create barriers to quality care. (4) Certain medical customs set the stage for marginalizing, objectifying, and pathologizing transgender people. Conclusions Transgender people experience harm via various aspects of EHR documentation, suggesting that changes must be made to improve patient-clinician relationships and reduce ill-effects for patients.

No abstract

This study was carried out, first, to determine the feasibility of postoperative home care for three elective operations and, second, to explore the feasibility of introducing postoperative home care as a more economical alternative for the following surgical procedures: herniorrhaphy, vaginal hysterectomy, and vein stripping. Clinical, environmental, operative, and socioeconomic criteria were applied to 487 outpatients of which 44 pairs were selected and matched by age, sex, diagnosis, environmental, and socioeconomic characteristics. Each member of a pair was randomly assigned to either hospital care or home care. The place of postoperative care was disclosed only after the operation. After three to five hours in the recovery room, the hospital care patient was transferred to the general surgical wards and the home care patient was transferred by ambulance to his home. There were two minor complications in the home care group and three in the hospital care group. The duration of convalescence was significantly shorter for home care patients with post–hernia repair and with hysterectomy. Economic analysis showed that from the hospital viewpoint, the average cost for both herniorrhaphy and hysterectomy home care patients is one–fourth of the average cost of hospital care. The home care alternative also provides for other savings which are described in the study.

The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. SUPPORT A.B.A.'s time is supported by an Agency for Healthcare Research and Quality T32HS000011. J.O.-M.'s time is partially supported by the National Institutes of Health (R21MD015878, R21CA237670, R01DA052016).