National Healthcare Quality and Disparities Report
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- Access to Care (5)
- Alcohol Use (1)
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- Care Coordination (1)
- Caregiving (1)
- Care Management (1)
- Children/Adolescents (7)
- Chronic Conditions (3)
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- Comparative Effectiveness (1)
- Cultural Competence (2)
- Depression (1)
- Disabilities (3)
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- Domestic Violence (1)
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- Family Health and History (2)
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- Health Information Technology (HIT) (2)
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- Health Services Research (HSR) (1)
- Health Status (1)
- Human Immunodeficiency Virus (HIV) (3)
- Lifestyle Changes (1)
- Low-Income (6)
- Medicaid (3)
- Medical Expenditure Panel Survey (MEPS) (1)
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- Medication: Safety (1)
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- Quality Measures (2)
- Quality of Care (1)
- Racial and Ethnic Minorities (3)
- Risk (1)
- Shared Decision Making (1)
- Social Determinants of Health (1)
- Substance Abuse (1)
- Surgery (1)
- Telehealth (1)
- Uninsured (2)
- (-) Vulnerable Populations (26)
- Women (1)
AHRQ Research Studies
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Research Studies is a compilation of published research articles funded by AHRQ or authored by AHRQ researchers.
Results
1 to 25 of 26 Research Studies DisplayedChan B, Edwards ST, Devoe M
The SUMMIT ambulatory-ICU primary care model for medically and socially complex patients in an urban federally qualified health center: study design and rationale.
Medically complex urban patients experiencing homelessness comprise a disproportionate number of high-cost, high-need patients. There are few studies of interventions to improve care for these populations; their social complexity makes them difficult to study and requires clinical and research collaboration. In this paper, the authors present a protocol for a trial of the streamlined unified meaningfully managed interdisciplinary team (SUMMIT) team, an ambulatory ICU (A-ICU) intervention to improve utilization and patient experience that uses control populations to address limitations of prior research.
AHRQ-funded; HS022981.
Citation: Chan B, Edwards ST, Devoe M .
The SUMMIT ambulatory-ICU primary care model for medically and socially complex patients in an urban federally qualified health center: study design and rationale.
Addict Sci Clin Pract 2018 Dec 14;13(1):27. doi: 10.1186/s13722-018-0128-y..
Keywords: Primary Care, Healthcare Delivery, Patient-Centered Healthcare, Vulnerable Populations, Chronic Conditions
Kranz AM, Dalton S, Damberg C
Using health IT to coordinate care and improve quality in safety-net clinics.
Health centers provide care to vulnerable and high-need populations. Recent investments have promoted use of health information technology (HIT) capabilities for improving care coordination and quality of care in health centers. This study examined factors associated with use of these HIT capabilities and the association between these capabilities and quality of care in a census of health centers in the United States.
AHRQ-funded; HS024067.
Citation: Kranz AM, Dalton S, Damberg C .
Using health IT to coordinate care and improve quality in safety-net clinics.
Jt Comm J Qual Patient Saf 2018 Dec;44(12):731-40. doi: 10.1016/j.jcjq.2018.03.006..
Keywords: Health Information Technology (HIT), Care Coordination, Patient-Centered Healthcare, Quality Improvement, Quality of Care, Vulnerable Populations, Care Management
Zuckerman KE, Chavez AE, Regalado Murillo C
Disparities in familiarity with developmental disabilities among low-income parents.
Parent knowledge about developmental disabilities (DDs) may facilitate access to DD care; however, parents may vary in their knowledge and familiarity with common DDs. The objective of this study was to assess racial/ethnic and language differences in low-income families' familiarity, knowledge, and personal experience with DDs. The investigators concluded that low-income Latino-LEP and other race parents have less familiarity or personal experience with DDs and are less aware of early signs of DDs compared to low-income white parents.
AHRQ-funded; HS000063.
Citation: Zuckerman KE, Chavez AE, Regalado Murillo C .
Disparities in familiarity with developmental disabilities among low-income parents.
Acad Pediatr 2018 Nov - Dec;18(8):944-51. doi: 10.1016/j.acap.2018.06.011..
Keywords: Disabilities, Children/Adolescents, Caregiving, Health Literacy, Low-Income, Vulnerable Populations, Racial and Ethnic Minorities
Moulin A, Evans EJ, Xing G
Substance use, homelessness, mental illness and Medicaid coverage: a set-up for high emergency department utilization.
The objective of this study was to identify characteristics unique to patients with psychiatric illness who are frequent emergency department (ED) users for mental health care. The authors suggest that understanding unique features of this population could lead to better care and lower healthcare costs. The authors concluded that patients with substance use disorders, homelessness and public healthcare coverage were more likely to be frequent users of EDs for mental illness.
AHRQ-funded; HS022236.
Citation: Moulin A, Evans EJ, Xing G .
Substance use, homelessness, mental illness and Medicaid coverage: a set-up for high emergency department utilization.
West J Emerg Med 2018 Nov;19(6):902-06. doi: 10.5811/westjem.2018.9.38954..
Keywords: Emergency Department, Medicaid, Healthcare Utilization, Behavioral Health, Substance Abuse, Vulnerable Populations
Bradley CJ, Neumark D, Walker LS
The effect of primary care visits on other health care utilization: a randomized controlled trial of cash incentives offered to low income, uninsured adults in Virginia.
Investigators recruited low-income uninsured adults in Virginia to determine whether cash incentives would encourage primary care provider (PCP) visits as opposed to going to the hospital emergency room. This randomized, controlled trial determined that PCP visits did increase but no reductions in overall costs occurred there was an offset from increased outpatient utilization.
AHRQ-funded; HS022534.
Citation: Bradley CJ, Neumark D, Walker LS .
The effect of primary care visits on other health care utilization: a randomized controlled trial of cash incentives offered to low income, uninsured adults in Virginia.
J Health Econ 2018 Nov;62:121-33. doi: 10.1016/j.jhealeco.2018.07.006..
Keywords: Healthcare Utilization, Health Insurance, Low-Income, Primary Care, Uninsured, Vulnerable Populations
Weitzman ER, Magane KM, Wisk LE
Alcohol use and alcohol-interactive medications among medically vulnerable youth.
Information about the prevalence of alcohol use among youth with chronic medical conditions (YCMCs) who take alcohol-interactive (AI) medications is scant. This study attempts to address gaps and inform interventions by quantifying simultaneous exposure to alcohol use and AI medications among YCMCs. Participants were adolescents with a variety of chronic conditions: type 1 diabetes, juvenile idiopathic arthritis, moderate persistent asthma, cystic fibrosis, attention-deficit/hyperactivity disorder, inflammatory bowel disease. Participants completed an electronic survey designed to measure prevalence of exposure to AI medications and associations with alcohol usage in the past year. Many of the participants reported alcohol use, but drinking was less likely among those who took AI medications. The authors conclude that perceptions about alcohol-medication interference mediated the association between drinking and AI medication exposure.
AHRQ-funded; HS022986.
Citation: Weitzman ER, Magane KM, Wisk LE .
Alcohol use and alcohol-interactive medications among medically vulnerable youth.
Pediatrics 2018 Oct;142(4). doi: 10.1542/peds.2017-4026..
Keywords: Alcohol Use, Children/Adolescents, Chronic Conditions, Medication, Medication: Safety, Patient Safety, Vulnerable Populations
Perez Jolles M, Thomas KC
Disparities in self-reported access to patient-centered medical home care for children with special health care needs.
The purpose of this study was to examine variation in caregiver service experience concordant with care in patient-centered medical home (PCMH) over time and by the characteristics of separate groups of children with special health care needs (CSHCNs). Researchers used 2003-2012 Medical Expenditures Panel Survey data for CSHCNs for cross-sectional pooled data analysis. Their conclusions suggest that disparities remain among high-need CSHCNs. Future research that focuses on a better understanding of how clinical settings tailor this care model, particularly to provide increased access and patient-centered care, is recommended.
AHRQ-funded; HS000032.
Citation: Perez Jolles M, Thomas KC .
Disparities in self-reported access to patient-centered medical home care for children with special health care needs.
Med Care 2018 Oct;56(10):840-46. doi: 10.1097/mlr.0000000000000978..
Keywords: Access to Care, Children/Adolescents, Disabilities, Disparities, Medical Expenditure Panel Survey (MEPS), Patient-Centered Healthcare, Vulnerable Populations
Schnall R, Cho H, Mangone A
Mobile health technology for improving symptom management in low income persons living with HIV.
This study aimed to examine the impact of an mHealth application (app), comprised of evidence-based self-care strategies, on the symptom experience of persons living with HIV (PLWH). In this 12-week trial, an mHealth app, mobile Video Information Provider (mVIP), was associated with improved symptom burden and increased medication adherence in PLWH.
AHRQ-funded; HS023963.
Citation: Schnall R, Cho H, Mangone A .
Mobile health technology for improving symptom management in low income persons living with HIV.
AIDS Behav 2018 Oct;22(10):3373-83. doi: 10.1007/s10461-017-2014-0..
Keywords: Chronic Conditions, Health Information Technology (HIT), Human Immunodeficiency Virus (HIV), Low-Income, Vulnerable Populations
Sen AP, Chen LM, Wong Samson L
Performance in the Medicare Shared Savings Program by accountable care organizations disproportionately serving dual and disabled populations.
The purpose of this study was to examine performance by accountable care organizations (ACOs) in the top quintile of their proportion of beneficiaries who were dually enrolled in Medicare and Medicaid (high-dual), and the top quintile of disabled beneficiaries (high-disabled). Measures used were quality scores, savings per beneficiary, whether or not the ACO shared savings and the amount of shared savings. The researchers found that high-dual and high-disabled ACOs had similar or higher spending than other ACOs at baseline, but achieved greater savings and were equally or more likely to earn shared savings; alternative payment models can have positive financial outcomes for providers serving vulnerable populations.
AHRQ-funded; HS024698.
Citation: Sen AP, Chen LM, Wong Samson L .
Performance in the Medicare Shared Savings Program by accountable care organizations disproportionately serving dual and disabled populations.
Med Care 2018 Sep;56(9):805-11. doi: 10.1097/mlr.0000000000000968..
Keywords: Disabilities, Medicare, Healthcare Costs, Provider Performance, Payment, Low-Income, Vulnerable Populations
Nguyen KH, Trivedi AN, Shireman TI
Lesbian, gay, and bisexual adults report continued problems affording care despite coverage gains.
This study’s investigators used data from three waves of the Behavioral Risk Factor Surveillance System to examine access to a personal doctor, affordability of care, type of health insurance coverage, and self-reported health in LGB adults in the period January 2014-February 2017 in thirty-one states that implemented the Affordable Care Act system's sexual orientation module.
AHRQ-funded; HS000011.
Citation: Nguyen KH, Trivedi AN, Shireman TI .
Lesbian, gay, and bisexual adults report continued problems affording care despite coverage gains.
Health Aff 2018 Aug;37(8):1306-12. doi: 10.1377/hlthaff.2018.0281.
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Keywords: Access to Care, Healthcare Costs, Health Insurance, Uninsured, Vulnerable Populations
Wong MS, Roberts ET, Arnold CM
HUD housing assistance and levels of physical activity among low-income adults.
The objective of this study was to assess whether participation in HUD housing assistance programs was associated with increased physical activity among low-income adults. The investigators found that receiving HUD housing assistance was associated with being physically active among nonsenior low-income adults.
AHRQ-funded; HS000029.
Citation: Wong MS, Roberts ET, Arnold CM .
HUD housing assistance and levels of physical activity among low-income adults.
Prev Chronic Dis 2018 Jul 19;15:E94. doi: 10.5888/pcd15.170517..
Keywords: Lifestyle Changes, Low-Income, Vulnerable Populations
Ouayogode MH, Meara E, Chang CH
Forgotten patients: ACO attribution omits those with low service use and the dying.
Alternative payment models, such as accountable care organizations, hold provider groups accountable for an assigned patient population, but little is known about unassigned patients. This study compared clinical and utilization profiles of patients attributable to a provider group with those of patients not attributable to any provider group. The study concluded that attribution approaches that more fully capture unattributable patients with low service use and patients near the end of life should be considered to reward population health efforts and improve end-of-life care.
AHRQ-funded; HS024075.
Citation: Ouayogode MH, Meara E, Chang CH .
Forgotten patients: ACO attribution omits those with low service use and the dying.
Am J Manag Care 2018 Jul;24(7):e207-e15..
Keywords: Access to Care, Patient-Centered Outcomes Research, Payment, Vulnerable Populations
Downing J, Conron K, Herman JL
Transgender and cisgender US veterans have few health differences.
The authors used population-level data for 2014-2016 from the Behavioral Risk Factor Surveillance System to compare the health of transgender and cisgender veterans and civilians. They found that, while transgender civilians had worse health than cisgender civilians across most indicators, very few differences existed among veterans. They conclude that their findings largely suggest that transgender veterans do not have worse health than cisgender veterans.
AHRQ-funded; HS022241.
Citation: Downing J, Conron K, Herman JL .
Transgender and cisgender US veterans have few health differences.
Health Aff 2018 Jul;37(7):1160-68. doi: 10.1377/hlthaff.2018.0027..
Keywords: Health Status, Healthcare Delivery, Vulnerable Populations
Fiechtner L, Perkins M, Biggs V
Rationale and design of the Clinic and Community Approaches to Healthy Weight Randomized Trial.
Recent studies have demonstrated the effectiveness of family-centered, pediatric weight management programs in reducing childhood obesity. Yet, programs to optimize the care of low-income children with obesity are needed. The investigators sought to examine the comparative effectiveness of two, potentially scalable pediatric weight management programs delivered to low-income children in a clinical or community setting.
AHRQ-funded; HS024332; HS022986.
Citation: Fiechtner L, Perkins M, Biggs V .
Rationale and design of the Clinic and Community Approaches to Healthy Weight Randomized Trial.
Contemp Clin Trials 2018 Apr;67:16-22. doi: 10.1016/j.cct.2018.01.002..
Keywords: Children/Adolescents, Obesity: Weight Management, Obesity, Low-Income, Vulnerable Populations, Nutrition, Patient-Centered Healthcare, Family Health and History, Evidence-Based Practice, Comparative Effectiveness
Nguyen OK, Higashi RT, Makam AN
The influence of financial strain on health decision-making.
This study sought to explore which unmet social needs are most influential and how these needs affect individuals’ decisions regarding medical treatment and self-management of health needs among community-dwelling low-income adults. It found that financial strain, rather than any single social need, was the most important factor in health decisionmaking among the underserved adults we studied, and may result in non-adherence to medical recommendations.
AHRQ-funded; HS022418.
Citation: Nguyen OK, Higashi RT, Makam AN .
The influence of financial strain on health decision-making.
J Gen Intern Med 2018 Apr;33(4):406-08. doi: 10.1007/s11606-017-4296-3.
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Keywords: Shared Decision Making, Healthcare Costs, Patient Adherence/Compliance, Patient-Centered Healthcare, Vulnerable Populations
Malik S, Lee DC, Doran KM
Vulnerability of older adults in disasters: emergency department utilization by geriatric patients after Hurricane Sandy.
Older adults are a potentially medically vulnerable population with increased mortality rates during and after disasters. To evaluate the impact of a natural disaster on this population, the authors of this study performed a temporal and geospatial analysis of emergency department (ED) use by adults aged 65 years and older in New York City (NYC) following Hurricane Sandy's landfall.
AHRQ-funded; HS024172.
Citation: Malik S, Lee DC, Doran KM .
Vulnerability of older adults in disasters: emergency department utilization by geriatric patients after Hurricane Sandy.
Disaster Med Public Health Prep 2018 Apr;12(2):184-93. doi: 10.1017/dmp.2017.44..
Keywords: Elderly, Emergency Department, Vulnerable Populations, Public Health, Healthcare Utilization
Leckman-Westin E, Finnerty M, Scholle SH
Differences in Medicaid antipsychotic medication measures among children with SSI, foster care, and income-based aid.
This study examined the application of 6 quality measures for antipsychotic medication prescribing in children and adolescents receiving Medicaid. While indicators of overuse were more common in those with Supplemental Security Income and foster care groups, access to follow-up, metabolic monitoring, and psychosocial services was somewhat better for these children. However, substantial quality shortfalls existed for all groups, particularly metabolic screening and monitoring.
AHRQ-funded; HS020503; HS019937; HS021112.
Citation: Leckman-Westin E, Finnerty M, Scholle SH .
Differences in Medicaid antipsychotic medication measures among children with SSI, foster care, and income-based aid.
J Manag Care Spec Pharm 2018 Mar;24(3):238-46. doi: 10.18553/jmcp.2018.24.3.238.
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Keywords: Children/Adolescents, Medicaid, Medication, Quality Measures, Vulnerable Populations
Cohen MS, Schpero WL
Household immigration status had differential impact on Medicaid enrollment in expansion and nonexpansion states.
This study identified households that likely included undocumented immigrants and then examined whether gains in health care coverage due to the expansion of Medicaid eligibility under the Affordable Care Act (ACA) were dampened for eligible people living in households with mixed immigration status. It found that coverage gains were significantly lower for people in mixed-status households relative to those in non-mixed-status households in nonexpansion states.
AHRQ-funded; HS017589.
Citation: Cohen MS, Schpero WL .
Household immigration status had differential impact on Medicaid enrollment in expansion and nonexpansion states.
Health Aff 2018 Mar;37(3):394-402. doi: 10.1377/hlthaff.2017.0978.
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Keywords: Health Insurance, Policy, Medicaid, Racial and Ethnic Minorities, Vulnerable Populations
Purnell TS, Marshall JK, Olorundare I
Provider perceptions of the organization's cultural competence climate and their skills and behaviors targeting patient-centered care for socially at-risk populations.
As part of a cultural competence needs assessment study at a large academic health care system, the study authors conducted a survey among 1,220 practicing physicians to assess their perceptions of the organization's cultural competence climate and their skills and behaviors targeting patient-centered care for culturally and socially diverse patients.
AHRQ-funded; HS024600.
Citation: Purnell TS, Marshall JK, Olorundare I .
Provider perceptions of the organization's cultural competence climate and their skills and behaviors targeting patient-centered care for socially at-risk populations.
J Health Care Poor Underserved 2018;29(1):481-96. doi: 10.1353/hpu.2018.0032..
Keywords: Cultural Competence, Patient-Centered Healthcare, Provider, Vulnerable Populations
Deans KJ, Minneci PC, Nacion KM
Health care quality measures for children and adolescents in foster care: feasibility testing in electronic records.
The objective of the study is to identify healthcare quality measures for young children and adolescents in foster care and to test whether the data required to calculate these measures can be feasibly extracted and interpreted within an electronic health records or within the Statewide Automated Child Welfare Information System. It found that electronic health records and the Statewide System data frequently lacked important information on foster care youth essential for calculating the measures.
AHRQ-funded; HS020503.
Citation: Deans KJ, Minneci PC, Nacion KM .
Health care quality measures for children and adolescents in foster care: feasibility testing in electronic records.
BMC Pediatr 2018 Feb 22;18(1):79. doi: 10.1186/s12887-018-1064-4.
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Keywords: Children/Adolescents, Electronic Health Records (EHRs), Quality Measures, Vulnerable Populations
Baggett TP, Berkowitz SA, Fung V
Prevalence of housing problems among community health center patients.
This study used data from a national survey to assess the prevalence and health-related correlates of housing problems among community health center patients. It found that, compared with those without housing problems, participants with housing problems were more likely to report health problems, emergency department use, and delays in care.
AHRQ-funded; HS025378.
Citation: Baggett TP, Berkowitz SA, Fung V .
Prevalence of housing problems among community health center patients.
JAMA 2018 Feb 20;319(7):717-19. doi: 10.1001/jama.2017.19869.
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Keywords: Community-Based Practice, Health Services Research (HSR), Vulnerable Populations
Adam GP, Di M, Cu-Uvin S
Strategies for improving the lives of US women aged 40 and above living with HIV/AIDS: an evidence map.
This work aims to identify and characterize empirical studies of strategies for the comprehensive management of women over 40, including transgender women, who live with HIV/AIDS. Few of the 37 eligible studies focused on women facing obvious challenges, such as immigrants, transgender, physically abused, or those recently released from prison. No studies focused on women caring for dependents, including children and grandchildren, or those diagnosed after age 40.
AHRQ-funded; 290201500002I.
Citation: Adam GP, Di M, Cu-Uvin S .
Strategies for improving the lives of US women aged 40 and above living with HIV/AIDS: an evidence map.
Syst Rev 2018 Feb 2;7(1):25. doi: 10.1186/s13643-018-0684-y.
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Keywords: Evidence-Based Practice, Human Immunodeficiency Virus (HIV), Vulnerable Populations, Women
Sun CJ, Sutfin E, Bachmann LH
Comparing men who have sex with men and transgender women who use Grindr, other similar social and sexual networking apps, or no social and sexual networking apps: implications for recruitment and health promotion.
This paper seeks to identify differences in men who have sex with men (MSM) and transgender women who use the Grindr app and those who use other similar apps. It found significant differences in the sociodemographic characteristics by app use, including age, race/ethnicity, sexual orientation, and outness. After adjusting for the sociodemographic characteristics associated with app use, there were significant differences in HIV risk and substance use between the groups.
AHRQ-funded; HS022981.
Citation: Sun CJ, Sutfin E, Bachmann LH .
Comparing men who have sex with men and transgender women who use Grindr, other similar social and sexual networking apps, or no social and sexual networking apps: implications for recruitment and health promotion.
J AIDS Clin Res 2018;9(2). doi: 10.4172/2155-6113.1000757.
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Keywords: Health Promotion, Human Immunodeficiency Virus (HIV), Risk, Social Determinants of Health, Vulnerable Populations
Khubchandani JA, Shen C, Ayturk D
Disparities in access to emergency general surgery care in the United States.
This study examined national emergency general surgery capacity and county-level determinants of access to emergency general surgery care with special attention to disparities. The study concluded that gaps in access to emergency general surgery services exist across the United States, disproportionately affecting underserved, rural communities and policy initiatives need to increase emergency general surgery capacity nationwide.
AHRQ-funded; HS022694.
Citation: Khubchandani JA, Shen C, Ayturk D .
Disparities in access to emergency general surgery care in the United States.
Surgery 2018 Feb;163(2):243-50. doi: 10.1016/j.surg.2017.07.026..
Keywords: Access to Care, Disparities, Emergency Medical Services (EMS), Surgery, Vulnerable Populations
Ragavan MI, Fikre T, Millner U
The impact of domestic violence exposure on South Asian children in the United States: perspectives of domestic violence agency staff.
The goal of this study was to examine the needs of South Asian children subjected to domestic violence, from the perspective of staff in domestic violence agencies across the U.S. in order to determine if the children required culture-specific resources. Thirty interviews were conducted; participants described factors important to understanding the impact of domestic violence on South Asian children and discussed the development of culturally tailored resources. The findings suggests that framing South Asian children's experiences within the context of interweaving South Asian and American cultural values, with attention focused on how potential culture clashes may impact the way children that process trauma, is important. The authors recommend that further work triangulate these themes between children, parents, and extended family and in collaboration with domestic violence agencies.
AHRQ-funded; HS022242.
Citation: Ragavan MI, Fikre T, Millner U .
The impact of domestic violence exposure on South Asian children in the United States: perspectives of domestic violence agency staff.
Child Abuse Negl 2018 Feb;76:250-60. doi: 10.1016/j.chiabu.2017.11.006..
Keywords: Access to Care, Children/Adolescents, Cultural Competence, Domestic Violence, Family Health and History, Racial and Ethnic Minorities, Vulnerable Populations