Achievements

Bridge D, Bruessow D, Fleming S. What can I do? Empowering Allies to Address a Public Health Crisis. 49th Annual Conference of the American Academy of PAs. Nashville, TN. May 23, 2023.

Bruessow D, Baker J, Dunn D, McLauglin K. Caring for Gender Diverse Patients in Your Practice. 48th Annual Conference of the American Academy of PAs. Held Virtually due to COVID-19. May 24, 2022

Sturgis D, Bruessow, D, Greenlee Q, Tshuma L. Toward Health Equity: Social Determinants of Health and PA Practice. 48th Annual Conference of the American Academy of PAs. Held Virtually due to COVID-19. May 24, 2021.

Bruessow, DM. Caring for Transgender and Gender Diverse Patients In Your Practice: Considerations Across the Lifespan. Annual CME Symposium. Vituity. Held Virtually. May 18, 2021

Summit to Define the Role of Oncology Advanced Practitioners in Equitable Cancer Care Delivery: Care Coordination, Clinical Trials and Implicit Bias. Steering Committee Member.

Bruessow DM, Dunn D, McLaughlin, K. Enhancing Care for Gender Expansive Patients with Telemedicine and Remote Care. National LGBT Health Awareness Week Forum hosted by the PAs in Virtual Medicine and Telemedicine, cosponsored by the LBGT PA Caucus. Held Virtually Due to COVID-19. March 23, 2021

Background: Health outcomes for gender minorities are influenced by the common and predictable systemic biases and judgement tendencies, resulting in assumptions that patients are cisgender. The US instituted meaningful use criteria for electronic health records that require fields for gender identity (GI) in addition to sex since 2015, and public awareness of gender diversity is increasing. Yet, medical professional’s awareness of patient GI and assigned sex at birth (ASAB) is unknown, as is the relationship between awareness, documentation and clinical decision-making. Specific Aim: The present study examined practice issues related to GI and ASAB at both the system level and individual participant level. The study investigated whether participant’s system-level patient intake process included a 2-question method for identifying GI and ASAB. At the individual participant practice level, the study examined the frequency of awareness of patient GI and ASAB prior to and 30-days following a quality improvement (QI) educational intervention, and whether awareness informed clinical decision making. Finally, the study explored whether system-level patient intake process influenced patient-level outcomes. Methods: A national sample of clinically practicing physician assistant (PA) participants (N=181), in 37 US states and Washington, DC, were identified via convenience sample. The cohort completed a random chart review pre-and post-intervention (30-days) later; study recruitment was from 2017-2019. Paired-samples analyses were conducted, with significance testing and effect size calculated for each effect. An additional system-level survey explored whether patient intake used a 2-question approach to GI and ASAB. A mixed-measures analysis of variance with measurement time (pre-or post-intervention) as a within-subjects factor and system-level patient intake process as a between-subjects factor was conducted to examine whether these factors interacted. Open-ended responses were collected but lacked specificity, preventing thematic analysis. Results: Individuals identified GI and ASAB separately in 9.89% of charts reviewed. Statistically significant improvements from pre-to post-intervention in awareness of 25.97% (9.89%, 35.86%, respectively) were observed, as well as informed clinical decision making 12.65% (7.3%, 20.00%, respectively). At the system level, a 2-question method for patient-intake, identifying GI and ASAB separately, was reported among 33.1% of the cohort initially. When scores were analyzed based on intake method, two patterns emerged. Pre-and post-intervention scores differed significantly between participants based on intake method F(1, 179) = 40.46, p< .001, partial ηp2= .18, and post-intervention ideal responses were significantly higher than pre-intervention as noted above, While there was an improvement in participants’ practices from pre-to post-intervention, and participants with 2-question patient intake reported more frequent awareness of patient GI and ASAB, these two factors did not significantly interact; the size of improvement from pre-to post-intervention was statistically equivalent regardless of patient intake procedure (23.97% vs. 30.00% improvement), F(1, 179) = 1.35, p= 0.25). Qualitative data identified a lack of participant awareness of the available fields for GI and ASAB within EHRs, and difficulty introducing these topics into the patient encounter, with some participants reporting their questions were poorly received by patients. Conclusion: Statically significant improvements regarding GI and ASAB awareness, documentation, and associated clinical decision-making may result from the 2-question method at intake as well as from the QI educational interventions. Even with large-sized effects in each category, participants were aware of GI and ASAB in only 53.33% of the post-intervention charts where the 2-question method was in use during patient intake, and some participants lacked awareness of the availability of GI and ASAB fields in their EHRs. Without explicit training, it is unlikely improvement will occur spontaneously, highlighting a need for further education.

The hosting organization is the PA equivalent of the AAMC. This meeting, and this presentation, is remarkable for the timing; it follows the release of new accreditation standards from the ARC-PA which includes a requirement to prepare graduates to care for patients with regard for social determinants of health, making this presentation, this year, especially meaningful to attendees. Social determinants of health (SDOH) are multi-level contributors that can negatively affect the health of patients. SDOH threaten health equity, disrupt health systems, and widen health disparity gaps. PA educators can serve as change agents in preparing a PA workforce equipped with the proper skills to assess and address SDOH. Learning Objectives: 1. Define SDOH. 2. Assess health literacy. 3. Discuss the association between SDOH and health disparities. 4. Understand the role of SDOH in health systems and health equity outcomes. 5. Compare and contrast health needs and outcomes among special patient populations. 6. Discuss strategies for incorporation of SDOH into PA curricula.