Table_1_Centralized and Decentralized Delivery of Transgender Health Care Services: A Systematic Review and a Global Expert Survey in 39 Countries.docx

IntroductionTransgender health care is delivered in both centralized (by one interdisciplinary institution) and decentralized settings (by different medical institutions spread over several locations). However, the health care delivery setting has not gained attention in research so far. Based on a systematic review and a global expert survey, we aim to investigate its role in transgender health care quality.MethodsWe performed two studies. In 2019, we systematically reviewed the literature published in databases (Cochrane, MEDLINE, EMBASE, Web of Science) from January 2000 to April 2019. Secondly, we conducted a cross-sectional global expert survey. To complete the evidence on the question of (de-)centralized delivery of transgender health care, we performed a grey literature search for additional information than the systematic review and the expert survey revealed. These analyses were conducted in 2020.ResultsEleven articles met the inclusion criteria of the systematic review. 125 participants from 39 countries took part in the expert survey. With insights from the grey literature search, we found transgender health care in Europe was primarily delivered centralized. In most other countries, both centralized and decentralized delivery structures were present. Comprehensive care with medical standards and individual access to care were central topics associated with the different health care delivery settings.DiscussionThe setting in which transgender health care is delivered differs between countries and health systems and could influence different aspects of transgender health care quality. Consequently, it should gain significant attention in clinical practice and future health care research.

引言
跨性别医疗服务既可在集中式（由单一跨学科机构提供）亦可在分布式（由分布在多个地点的不同医疗机构提供）的环境中实施。然而，迄今为止，关于医疗服务提供环境的探讨尚未引起研究界的关注。基于系统性回顾及全球专家调查，本研究旨在探讨其在跨性别医疗服务质量中的作用。
方法
本研究开展了两项研究。2019年，我们对数据库（Cochrane、MEDLINE、EMBASE、Web of Science）中2000年1月至2019年4月发表的文献进行了系统性回顾。其次，我们进行了一项横断面全球专家调查。为了补充关于跨性别医疗服务（去）集中式提供问题的证据，我们进行了灰色文献搜索，以获取系统性回顾和专家调查之外的信息。这些分析于2020年进行。
结果
系统性回顾中符合纳入标准的文章共有11篇。来自39个国家的125名参与者参与了专家调查。基于灰色文献搜索的洞察，我们发现欧洲的跨性别医疗服务主要采用集中式提供。在大多数其他国家和地区，集中式和分布式提供结构并存。具有医疗标准和个体化医疗服务接入的综合护理是不同医疗服务提供环境下的核心议题。
讨论
不同国家和卫生体系中跨性别医疗服务提供的环境存在差异，并可能影响跨性别医疗服务质量的多个方面。因此，它应在临床实践和未来的医疗服务研究中获得显著的重视。