Ashley . Hi. Were waiting for okay. Great. I want to thank you, commissioners, for having us . My name is ashley scarborough, and im working in primary care central . Its my pleasure to represent a large and Interdisciplinary Group and working to include lgbt in the group, so thank you . For this initiative, its really more than Data Collection . It offers an opportunity for staff to align with our values and moving towards True North Equity creating culture change and ultimately providing more inclusive care for the lgbtq population. I want to recognize the longer term efforts in the department for gender equity Data Collection . And just the staff advocating for this data and advocating for this community so aligning with that over the last few years has also been structural policy incentives and mandates that have been elevating the priority of Data Collection, including local ordinances authored by scott wiener, state legislative bills, and payforperformance dollars, part of the prime program over three years, 1. 7 million for the collection of Sexual Orientation and gender identity data . Each of these mandates have focused on Data Collection, and i think one area of strength of the Department Overall was our leveraging of these incentives and mandates to build out our own goals for lgbtq equity . So this is a a sort of detailed slide where im going to talk about the robust and thoughtful planning process that staff and workforce along with patients from the community put into this project . First of all, there was an emphasis on training, so there was a desire to not just develop workforce for collecting the data but also ensure that staff had what they needed to respond appropriately to this community and act with nondiscrimination, of course. There was a Large Department wide effort with the train the trainer model where our internal Training Resources were trained and developed to disburse this training throughout the department . So Division Leaders came together, developed a curriculum. It was a modulized curriculum, so we could be adaptive to the needs of star aff and their go. Theres a threehour training, theres a shorter one hour, and theres online. We let staff know that one, they were required to ask everybody, and two, patients could decline. And patients also had training material explaining the purpose of these questions, and they had the right to decline to obviously any or all of the questions . And then, i think one element that were all proud of is the continued focus on patient experience. The best example of this for our project was focusing on name and pronoun to make sure that we were expanding just collecting this information about peoples identities and also making sure that we were providing the best care for patients by addressing them appropriately and affirming their identity throughout their experience in the department. To do this, we had to in g legacy data systems, we had some complicated work arounds to be able to do this to be able to have chosen names printed on wristbands, and im excited to report that epic is a huge improvement for this part of our initiative. And i know the commission had some interest in that, so inside of that this is a test record you can see the persons name and their pronouns available in the header of every, like, chart thing . And there was also interest in legal sex because now california does have a third gender, and so this was available in epic, so we have more opportunity for our patients to identify correctly throughout the network and department . I want to talk a little bit more about our training . I think this was a huge Department Wide effort, and its still going on with the department of Population Health where you can see they had just a slightly later start than the rest of the department . For the first column, i just want to add a caveat that this was an estimated denominator of just d. P. H. Employees and of course multiple employers and organizations are working in the department who are also trained, including ucsf and various contractors, so those numbers dont always match as far as enumerators and denominators, but total touches in the department, over 8,000 participated in either im sorry. Over 5,000 participated in either inperson or online training. Approximately 70 of our staff have had some encounter with the training. And there was another question about laguna honda, and i wanted to recognize the leader, ami fishman, as far as coordinating the development and disseminating the training for the department. You can see theyre kind of ahead of the rest of the department as far as making sure their new hires are also trained . And so thats why we got over the 100 , and so i think theyre a model, and were exploring ways as a team to maintain training on board as we acquire new staff so they can be acclimated in our values. Okay. Here is a broad overlook of each this is our primary care populations. These are people who have interfaced with primary care, and you can see that over time with this initiative, weve had good progress, including just a 33. 24 increase just this year . And that represents 19,202 patients as of may who actually have data complete in their record. These numbers also show that weve met our payforperformance targets all three years as a program, so weve reached the 1. 7 million attached to this project. And additionally, i think we would all like to see these numbers even higher. I think that as a city and as a system and as a department, theres a lot of interest and engagement with this, and we would like to be a demonstrator in lgbtq equity around the country . And well be watching for improvements that are attributable to epic in Going Forward, and we know that theres variation among sites. And again, these reports in the last year are based in our legacy data where theres some challenges showing the very variety around the department . Im going to jump ahead a little bit where i can show with our l. C. R. Encounter data how were doing by division. And you can see that theres quite a widespread in encountered in may that had data complete. So i think this gives us, like, an idea of where we want to work towards in the next year as we get acclimated to especially, where our target sites are being and reconvening some of these data from patients so we can have even higher numbers Going Forward. And skip back again. So even though these numbers, because its demographic collection, we would be getting it on every patient that we did see in the department. Were not there yet, but the exciting news is that we have more data on the population than weve ever had before, with over 50 of our population being complete, we can start to see trend dos. And im just going to walk you through these really quickly. This is in the population really quickly. So for our adults over 18, weve had a primary care visit. Weve had almost 14 in the sexual minority population, and those identities included gay, lesbian, neither, and experimenting. For transitional age youth, age 18 to 25, we see a bump again for 15 , and then in our homeless population, you can see a disproportionate number of lgbtq patients. I think that one interesting thing about these early trends is they do match with what people guessed and assumed as far ased the majority of these patients being seen at castro and mission and positive health. But the one i want to hit is that everyone around the city in each of these clinics. No one gets a pass from building lgbtq equity at their site. I think thats really important to keep in mind. Here again for gender minority populations . And this includes people who recorded for their gender identity, transgender female, transgender male, gender nonbinary or not listed. And we see about 2 for adults 18 and over. For transitional age youth, you see a lot more gender freedom for younger populations, and again, thats an incentive and motivation to get more prepared for meeting the needs of this population. And again, disproportionate number in our health care for the homeless population. And i would make the same point here. I dont think anyone was surprised that we had a higher in mission castro, but we have a widespread of patients touching our sites. I wanted to share a story i found moving for curry senior center. Right when we started, jen gurley was the primary care director. She reported one of the patients was moved to tears for the first time being recognized and affirmed and sort of seeing for the first time having these questions asked at the clinic. So, like, had the opportunity to go back to our seniors who did so much for our Lgbtq Movement and fold them back into the health care measures is really meaningful. And im going to take you drill back down into our encounter data across the department . You can see that were having pretty even spread for our sexual minority population and where theyre being seen throughout the network is slightly higher in primary care, and these are the encounter with surgery complete in may. And this does the same thing for gender minority populations . I think that whats most striking about this particular slide is that high percent in psychiatric emergency, and they reported that anecdotally to us, and were heavily involved in the roll outof this initiative, and rollout of this initiative. And theres just one caveat. They do have smaller numbers than the rest of the number. But in any given month, they will see this percent of gender expansive population and receiving their services. And i saw this a lot during the training, so its not, like, biological or faded that people with expansive gender identities will have psychiatric concerns or Mental Health issues. Its definitely a product of our society and how these people are treated. It affects their capacity to to have sorry. Im having problems going over my words. Im i want to say this right and honor this community because it is about what what what what affects them and how theyre treated in the world. So i think this was going to go to the heart and the intent of the different mandates and incentives that we do have, which is to promote equity in health disparities. I just want to walk you through this on the left. So a lot of our focusing on outcomes, a lot of our metrics are actually gendered. Chlamydia screening is one of our gendered metrics. You can see that in the light blue, so young women are more likely to be screened. Weve done our gender minority population, and the same for straight women compared to sexual minority. And i want to emphasize because of our incomplete data, these are early analysis. Just Something Interesting to think about Going Forward where we can make work to improve Health Equity in this community. For on the right, matching national trends, you see higher diagnosis of depression in this community, and i think that, you know, where were working to do depression training, this is motivation to make sure that were not leaving anybody out as we roll out our Quality Improvement metrics Department Wide. Okay. Okay. So i just want to tie it together and end and say that some of things that were proud of that we want to Carry Forward into the future is prioritizing patient experience. Whatever we get a grievance from this population, we want to make sure were responding with training, making sure that all of our services are inclusive, and were providing good access to the lgbtq community. The big transition for all us, epic, we want to make sure were having a smooth transition to that. Whatever kind of tools weve developed to make sure they understand how to use the various pronouns, and all the tools that we didnt have before, and lastly looking into our disparities and outcomes, so that we can private targets interventions and equity in the lgbtq population. Welcome any questions. Is there any Public Comment . Ive not received any Public Comment for this item. Its now in the hands of the commissio commission. Thank you, miss t scarborough. Dont leave. Okay. Commissioner brown . Thank you for those stories about the lgbtq person. Youd mentioned that wed met our targets currently, which i think allowed another 1. 7 million to flow. You said. I know there are a lot of incentives on the local, state, and federal level. Are there anyplaces in which were any places in which were behind . You know, i think when we compare ourselves to other places in the state and maybe other departments in the city where theyve just given out demographic forms to everybody, they might be having a higher percent of complete than us. While i think were not, quote, unquote, in compliance, i think where we want to be is not where were at right now because wed love to be more in the 80 to 90 complete . And so can can for compliance and reporting, i think were not behind, but when we compare ourselves to our peers, we could be doing more Data Collection. Also looking at the measure that youre using for implementation and completion, youre using completely other primary care visits for 12 months, so presumably, were going to see higher numbers because anybody that had a visit would be in epic, correct . Yeah. And i think where well also expand because we have more integrated access into the encounters, more information on people who have have had various touches outside of primary care in the department, so i think well see our numbers go up next year. So when we see next year, well see our numbers up around 80, right . Yeah. Okay. Good. Thank you. Commissioner green . Thank you for this incredible work youve done. Im curious about your data gathering, and i have two questions. One, do you have any idea about the individuals that will be entering this data and their collection, and then, to try to get a view of San Francisco in general, can you access this type of epic data from other health centers, like an emergency room at st. Francis or any touch point in the city . Because i think creating a citywide cultural sensitivity is understanding our population and getting as much data as possible. I guess my last question is what is your intended increase in percentages of data . Do you think when you get more of a data, these percentages will change . Those are great questions. Theres some controversy about whether its Demographic Data or whether its clinical data, but the field is shifting to making it Demographic Data. One, it normalizes it, and two it really increases the volume in which you collect compared to if you make it a clinical work flow. So to answer the first question, its a front office work flow. Now, we have a Schedule Star workforce, and theyre the people that are going to be collecting and entering this. Your second question about maybe comparing to other systems around the city as much as we can because the entire city, except for the catholic systems, are on epic. Thats great. I dont think weve thought about that, but with epic and care everywhere, thats possible. Epic has released, just this last year, their more expansie module for data collecting. I think there is some efforts from the office of transgender initiatives and citywide to sort of understand where were at as a city among all of our entities and anywhere we would touch this community . And then, your last question was about our anticipated percentages. Okay. Yeah. I think 80 is where we want to be for the end of this fiscal year. Okay. Thank you. Other questions or comments from commissioners . Commissioner guillermo . I dont have a question. I just wanted to congratulate you on the report and all of the hard work you and your colleagues are doing to establish sort of the baseline information and really sort of set an example for what we should be doing in health care around the collection of data in anything, particularly the coordinated collection, and i think its fortuitous that we have epic and their support. Thank you. So this is only within the department of Public Healths purview. It doesnt include our nonprofit providers at all . Thats a great question. Where we had access to our legacy data systems are more in our department of Public Health . I think that Behavioral Health has been sort of a leader in dealing with multiple contractors and multiple data systems . And i do look forward when they also join us on epic, when we can share our data more easily and also share information which youre all alluding to to have more information about our contractors who are involved with Behavioral Health services. Are there other contractors that you had in mind . So for the current system, they havent switched over to anything, but in their current system, they are supposed to be collecting it. The contractors through Population Health or some of those that its less clear that they are collecting demographics, even, they are not necessarily required to, but its all of those Behavioral Health contractors. And dr. Bennett, could you introduce yourself for the public. Im sorry. Im dr. Ana bennett, and this project was in my purview. Thank you. Itll be interesting to see as we look at the whole city of San Francisco, not just internal to the department, what the data would look like. I think that 80 number would below. I think youll go wait beyond that if we are way beyond that if were able to get that data. And its not easy because it is outside of our epic system. Commissioner chow . Yes, and this is in follow up to your statement about the contractors in the court. The Mental Health contractors are our biggest contractor, and they are on a different system. Yes. Youre saying that that system is currently collecting data within their system . We did put in fields in aven avatar, and so we are monitorin