Foundation, whether on the outcomes of the health of the patients have been impacted in terms of that transfer. Because part of the concern was when you move from, you know, a number of concerns, but when you move from sort of a Hospital Management of the service to the medical foundation, management of the service, does that change the nature of the services in such a way that it impacts the Patients Health . I dont think i have that data at this point in time. If youre referring to the diabetes, i can say with a lot more certainty that with the Breast Health center or with the noninvasive cardiology, its the exact same machine. Its read by the same radiologist or cardiologist. So i would have no doubt that should not have any significant impact. In terms of tracking diabetes before and after, because many of these are not necessarily Sutter Pacific medical foundation patients, so we dont necessarily have all of their medical record, access to them easily. And so especially before. And so its one of these things where it would be a little bit harder for me to i think think about if there are ways to do it. But at this point in time, that medical record data, because theyre not necessarily seen by our primaries or endo criologists per se. It would be helpful if there was sort of a way to observe or to analyze. And if you do, particularly for those patients who are sort of seen by the same provider, if theres a way. Because i think thats an important piece of just sort of considering, you know, these kinds of changes, whether its diabetes or others, that access is one thing. But were really concerned also about the impact on residents and patient health. We may have some data. But we can certainly look into that. Commissioner chow. Commissioner chow i was just also going to comment, im really pleased also that the institute of aging was able to actually complete their work in leasing over at the presidio. And that that seems to be really for that portion of that program and transferring it out of cpmc and then to i. O. A. And expanding it, i think has been a positive for us. And i hope that we will the minutes will reflect what the relationship so i. O. A. Other comments, questions . Also im sorry. If were going to we think that is a benefit to the city. Gotcha. Next item. Clerk item 7 is an action item. Its A Laguna Honda hospital and Rehabilitation Center medical staff bylaws and rules and regulation. Just a reminder, commissioner, they recommended that you that the full commission approve this document after review at the may 14th meeting. Thank you. Good afternoon, president loyce, members of the Health Commission and dr. Colfax. Im the c. E. O. At laguna hospital. On behalf of dr. S hathaway and dr. Mcshane. They have worked with the City Attorneys Office since august of 2018. And also worked to align the medical staff bylaws to align with the medical staff bylaws with the laguna honda bylaws revision. And a they have consulted with dr. Chow, as our resident bylaws consultant with the department. I am here to request your approval for the revisions of the laguna honda medical staff bylaws. Thank you. Theres no Public Comment request for this item. Because it comes from a committee, we dont need a motion, do we . Oh, actually youre correct. It usually is there usually is a motion here. You are correct. So we can just vote to adopt as a commission. So all those in favor of adopting adopting this report say aye. Aye. I say aye as well. All right. Thank you. Thank you very much. Thank you. Item 8 is the sfdph gender health s. F. Update. And please let me know if you need any help over there. Good afternoon, commissioners, my name is jenna rapues. Im the Program Director for sfdph. I want to thank you all for inviting us to provide an update of our program. Just a little bit about myself. So im actually joined by my colleagues as well, the medical director and the evaluator for our program. And just f. Y. I. , the pronoun used is she, her. As an information. All right. I live by myself, i am celebrating my oneyear in the program, actually as a Program Director, its been a wonderful experience to actually be involved in the program, that has actually centering the experiences and needs of trans folks in San Francisco, with regards to access and whatnot. My background basically is i before i joined general sfdph, i was doing with a threeyear with u. C. F. And i was doing capacitybuilding on a National Level and also at the time i had left, i was also the interim director for the center for Transgender Health and transitioned back to the program. So with that history, im interning in the department, prior to that working in Population Health and h. I. V. Prevention and research and whatnot. So with that i wanted to highlight i really wanted to first establish and show with you all that were celebrating today a major milestone in the program. We reached 1,000 surgery referrals in our program, which is a huge milestone. So we want to really honor that and really celebrate that and the work that weve done for the past i think seven years now. And well get a little bit more indepth about the data so far. Well talk about that more in terms of a Patient Population, but just wanted to share that. That is a huge milestone for the department to be able to move patients through, through surgeries. So sfdph navigates them surgeries, procedures and resources in order to help members of the transsexual, transgender and gender nonbinary people to achieve their hopes and dreams. We are a referralbased program in which patients, who require gender surgery are referred for education and preparation. And navigation and facilitation to getting steps we were established in 2013 by the department to provide access, again to gender referral surgeries. For those who are insured and eligible for our program. So currently sfdph provides a wide range of Health Services to transand nonbinary residents, such as primary care, be it for health, preventative care, hormone therapy and numerous other initiatives in the department, that really serves the population, which includes the Population Health and other initiatives that are within this department. I also wanted to note that we submitted some Supplemental Information that you all may have had, which speaks a little bit more about our basically [indiscernible] that really speaks to our program eligibility, our Insurance Coverage and navigation services, which is the core and the heart of our program. And also the history that speaks to a more contextual and detailed history of our program in the way in which serves different surgeries have actually become more available, rarely available over the time, so that theres a supplemental document that speaks to that. And also our staffing structure. But speaking to the Mission Statement, this is something that weve actually developed this year. And our Mission Statement basically is to increase access to Quality Health care for underserved trans and nonbinary people in San Francisco, regardless of immigration status and their lack of income. And the values that we hold true to our program, includes social justice, community investment, peerled harm reduction, wellness, advocacy, and compassion wholeperson care. Just a few milestones that i mentioned earlier, the information that really speaks to more detailed information around programs and milestones. But just a few milestones and i think the doctor may talk about this a little bit more later. But i think just i really want to frame the way in which weve had a really extensive collaboration and partnership with the Trans Community and the program really came out of that partnership, which really started in 2013, where the board of supervisor adapted a resolution that deemed these surgeries as medical necessity. So it really sparked the interest and the commitments from our department to really develop a program such as ours. And with the Health Commission actually approving surgery access for development in 2012, right. In 2013, the department managed health care, solutions were removed, which actually increased access and increased interest to get these surgeries for our Patient Population. So that expanded our program and enhanced also we launched at the time it was called Transgender Health services. I can recall back where transgender, just a small space. I think the doctor can talk about a space, which was in a closet at the c. I. V. , which really tells about where we came from and where were at now as a program. In 2017, my predecessor julie graham really zillion a lot of work to develop the program and expanding the services and actually expanding the capacity and staffing of our program. Where, you know, weve included weve hired more staff, included more Civil Service staff to really increase our capacity to respond to the need and demand. At the same time, too, in 2017 we moved from the closet here at the ivy to a space at cfhg. Ward 86 really has proven to be really Great Success in being able to serve the population through the work that were doing and really being developing programs in the department. And in 2017, we adapted a new program called gender health s. F. In 2018, i came on board to really come in with my experience, with the department, and also really kind of sparking interest and kind of taking on the next the next roles of our program and the next iteration of the program. Im going to turn it over to seth, who will talk a little bit more about our Patient Population, demographics and our metrics and outcomes. Thank you, commissioners, for having us here. My name is seth, and i [indiscernible] under the client demographics, im the lead for the Program Evaluation for gender health s. F. And the Program Evaluation began in 2016. As part of this Program Evaluation, we have a lot of indicators, many of which i will show you here. For the client demographics, through the end of calendaryear 2018, approximately just over 500 unique patients, threequarters of this population that we serve, through this program, are trans women, a majority of them are people of color, who are of early, middle age, between the ages of 25 to 44, with low education, 50 , some college and more a quarter unstably housed and a majority are unemployed or on some sort of public assistance. And this flag here shows how our primarily transgender and nonbinary sample compares to a 2015 National Survey of trans individuals and gender nonbinary individuals. This next slide that talks about some of the quantitative evaluation highlights shows the trend of referrals received. The blue line which has systematically gone up since the in 2013, were also on track, as jenna mentioned, to hit 200 referrals this year in 2019. Were about halfway there. Halfway through the year. And the orange line, insurgentries surgeries completed remained relatively flat since 2013. But what this suggests is the demand for the services are increasing, while our capacity to meet those needs are remaining relatively flat. For surgery wait time, if there are questions about this, i do have more information than what it presented on this slide. But generally speaking, were seeing a longer wait time for services that are heading out of network, which are primarily our genital surgeries, than compared to our innetwork services, which are our chest and breast surgeries. Based on the outcome day taxer data, the program intake, at baseline, our clients are showing pretty good overall, general overall health, being to a National Sample of trans individuals, theyre showing less, serious psychological distress as defined by the kessler six, serious psychological distress scale. Less alcohol and tobacco use, but were seeing more cannabis use. What this suggests from an evaluation standpoint, is that because our referrals to gender health s. F. Are being received through the primary care system, people are already engaged in care by the time they engage with gender health s. F. So theyre receiving primary care, theyre engaged in services, so its not surprising to me, that given the vulnerability of this population, we are seeing Better Overall Health, less serious psychological distress and less alcohol and tobacco use, compared to a general population of trans people. One thing i do want to point out, though, is that when we did our education and programming, we do this while the patients are waiting to have their surgeries, we find that a majority of clients agreed or strongly agreed that the education and programming was valuable and worthwhile. And clients felt that very or completely ready for surgery, as a result of participating in the preparation and Education Services with gender health s. F. s peer Navigation Team. Clients were learning about the possible surgical complications, they were learning how to have realistic postoperative expectations, they were learning about the importance of of having social structures in place leading into the surgeries, so they had good recovery social support, which maximizes the benefits to them in their recovery period. And for managing stress. In addition, where the data allowed, we did see we did some Statistical Analysis and we were able to show as a result of participating in this program and working with the peer navigation staff. Less body discomfort following surgeries, less reported gender dysphoria following surgeries and a significantly increased psychological quality of life, as measured by the w. H. O. Quality of life brief scale. We did show trends, although they werent systematically significant of lower psychological distress measured through the case six. And better social relationship quality, as measured by the w. H. O. Quality of life scale. And the majority of the sample said that they felt that their health was better today than a year ago. Just some brief summary of the quantitative information that came out of the interview for the Program Evaluation. We found that threequarters of the patients that we were able to interview oneonone, for the Program Evaluation, felt that they were treated with respect, they felt safe with their procedures, they felt that the care team was available to them. And the navigators provided an incredible amount of connection and support. And some of the challenges that they reported with care quality were that some of the medical providers they felt lacked a agree of cultural humility, they were being misgenderred a little bit, they werent using the correct propronouns and hearing conflicting information between the surgical staff and then the surgeon themselves. But they did feel that the Navigation Team was able to help them go through the surgical process and get clarity in the information that they need to have a good outcome. The majority of the patients felt that they had positive Care Experiences, that they were treated primarily with respect, that the care team listened and paid attention to them and that they felt more comfortable in their body after surgery, again they attributed most of this to working with the peer navigation staff. Most of them felt that they just they would say over and over again, how relieved they were to have this kind of access and support from the Navigation Team to feel like they were able to access the service, to be authentically themselves, a dream they never thought they would have access to, because of their economic circumstance. And just historically they have not been permitted to access these services. So one thing thats really that i have learned over the past year, that ive been the director as the program, is this [indiscernible] and previously julie graham, which is we are building the shape as we sail. So we are in full operation, but we are relatively Young Program in the department. So we are still in the process of really kind of contemplating and reflecting on the challenges and also kind of our accomplishments and some of the gaps within the systems. So really just wanted to highlight with you all and share with you all are some of the things that we as a program have been reflecting on. In terms of systems, gaps and needs, some of the things that are important to us, that have been some challenges also is the concept of when youre in care, which should actually can be a barrier for some of our Patient Population. So really thinking through what that would look like in terms of different standards that maybe recommended for our Patient Population. And a barrier that really exists for our spark spanishspeaking its Language Access and similarly to patient education materials easily translatable in spanish. So thinking through what that would look like for our Patient Population. Often times we provide trainings in our work, so we have actually we actually have a trainer who is providing different types of training capacity around