Sexual Orientation and Gender Identity Data Collection in Clinical Settings and in Electronic Health Records: A Key to Ending LGBT Health Disparities
Abstract
The Institute of Medicine's (IOM's) 2011 report on the health of LGBT people pointed out that there are limited health data on these populations and that we need more research. It also described what we do know about LGBT health disparities, including lower rates of cervical cancer screening among lesbians, and mental health issues related to minority stress. Patient disclosure of LGBT identity enables provider–patient conversations about risk factors and can help us reduce and better understand disparities. It is essential to the success of Healthy People 2020's goal of eliminating LGBT health disparities. This is why the IOM's report recommended data collection in clinical settings and on electronic health records (EHRs). The Center for Medicare and Medicaid Services and the Office of the National Coordinator of Health Information Technology rejected including sexual orientation and gender identity (SOGI) questions in meaningful use guidelines for EHRs in 2012 but are considering this issue again in 2013. There is overwhelming community support for the routine collection of SOGI data in clinical settings, as evidenced by comments jointly submitted by 145 leading LGBT and HIV/AIDS organizations in January 2013. Gathering SOGI data in EHRs is supported by the 2011 IOM's report on LGBT health, Healthy People 2020, the Affordable Care Act, and the Joint Commission. Data collection has long been central to the quality assurance process. Preventive health care from providers knowledgeable of their patients' SOGI can lead to improved access, quality of care, and outcomes. Medical and nursing schools should expand their attention to LGBT health issues so that all clinicians can appropriately care for LGBT patients.
Get full access to this article
View all available purchase options and get full access to this article.
References
1.
Boehmer UBowen DJBauer GR. Overweight and obesity in sexual minority women: evidence from population-based dataAm J Pub Health2007971134-1140. 1. Boehmer U, Bowen DJ, Bauer GR: Overweight and obesity in sexual minority women: evidence from population-based data. Am J Pub Health 2007;97:1134–1140.
2.
Valanis BGBowen DJBassford TWhitlock ECharney PCarter RA. Sexual orientation and health: Comparisons in the Women's Health Initiative sampleArch Fam Med20009843-853. 2. Valanis BG, Bowen DJ, Bassford T, Whitlock E, Charney P, Carter RA: Sexual orientation and health: Comparisons in the Women's Health Initiative sample. Arch Fam Med 2000;9:843–853.
3.
Kerker BDMostashari FThorpe L. Health care access and utilization among women who have sex with women: Sexual behavior and identityJ Urban Health200683970-979. 3. Kerker BD, Mostashari F, Thorpe L: Health care access and utilization among women who have sex with women: Sexual behavior and identity. J Urban Health 2006;83:970–979.
4.
Conron KJMimiaga MJLanders SJ. A population-based study of sexual orientation identity and gender differences in adult healthAm J Pub Health20101001953-1960. 4. Conron KJ, Mimiaga MJ, Landers SJ: A population-based study of sexual orientation identity and gender differences in adult health. Am J Pub Health 2010;100:1953–1960.
5.
Feldman J. Medical, surgical management of the transgender patient: What the primary care clinician needs to knowFenway Guide to Lesbian, Gay, Bisexual, and Transgender HealthMakadon HMayer KPotter JGoldhammer HPhiladelphiaAmerican College of Physicians2008372-373. 5. Feldman J: Medical and surgical management of the transgender patient: What the primary care clinician needs to know. In: Fenway Guide to Lesbian, Gay, Bisexual, and Transgender Health. Edited by Makadon H, Mayer K, Potter J, Goldhammer H. Philadelphia: American College of Physicians, 2008, pp 372–373.
6.
U.S. Department of Health and Human Services: Healthy People 2020. Lesbian, gay, bisexual and transgender healthwww.healthypeople.gov/2020/topicsobjectives2020/overview.aspx?topicid=25November42011. 6. U.S. Department of Health and Human Services: Healthy People 2020. Lesbian, gay, bisexual and transgender health. www.healthypeople.gov/2020/topicsobjectives2020/overview.aspx?topicid=25 (accessed November 4, 2011).
7.
Collins Higgins PFries Taylor EMeasuring Racial and Ethnic Disparities in Health Care: Efforts to Improve Data CollectionPrinceton, NJMathematica Policy Research, Inc.2009www.mathematica-mpr.com/pdfs/health/DisparitiesHealthcare.pdfJuly262013. 7. Collins Higgins P, Fries Taylor E: Measuring Racial and Ethnic Disparities in Health Care: Efforts to Improve Data Collection. Princeton, NJ: Mathematica Policy Research, Inc., 2009. www.mathematica-mpr.com/pdfs/health/DisparitiesHealthcare.pdf (accessed July 26, 2013).
8.
Loo TDavis RLipsitz LIrish JBates CAgarwal KMarkson LHamel M. Electronic medical record reminders and panel management to improve primary care of elderly patientsArch Int Med20111711552-1558. 8. Loo T, Davis R, Lipsitz L, Irish J, Bates C, Agarwal K, Markson L, Hamel M: Electronic medical record reminders and panel management to improve primary care of elderly patients. Arch Int Med 2011;171:1552–1558.
9.
Hasnain-Wynia RPierce DHaque AHedges Greising CPrince VReiter JHealth Research and Educational Trust Disparities Toolkit2007www.hretdisparities.orgApril92013. 9. Hasnain-Wynia R, Pierce D, Haque A, Hedges Greising C, Prince V, Reiter J: Health Research and Educational Trust Disparities Toolkit, 2007. www.hretdisparities.org (accessed April 9, 2013).
10.
Panel on Racial and Ethnic Disparities in Medical Care Convened by Physicians for Human RightsThe Right to Equal Treatment: An Action Plan to End Racial and Ethnic Disparities in Clinical Diagnosis and Treatment in the United StatesBostonPhysicians for Human Rights200329. 10. Panel on Racial and Ethnic Disparities in Medical Care Convened by Physicians for Human Rights: The Right to Equal Treatment: An Action Plan to End Racial and Ethnic Disparities in Clinical Diagnosis and Treatment in the United States. Boston: Physicians for Human Rights, 2003, p 29.
11.
The Joint CommissionAdvancing Effective Communication, Cultural Competence, and Patient- and Family-Centered Care: A Roadmap for HospitalsOakbrook Terrace, ILThe Joint Commission2010. 11. The Joint Commission: Advancing Effective Communication, Cultural Competence, and Patient- and Family-Centered Care: A Roadmap for Hospitals. Oakbrook Terrace, IL: The Joint Commission, 2010.
12.
Diamant ALSchuster MALever J. Receipt of preventive health care services by lesbiansAm J Prev Med200019141-148. 12. Diamant AL, Schuster MA, Lever J: Receipt of preventive health care services by lesbians. Am J Prev Med 2000;19:141–148.
13.
Committee on Lesbian, Gay, Bisexual, and Transgender Health Issues and Research Gaps and Opportunities; Board on the Health of Select Populations; Institute of MedicineThe Health of Lesbian, Gay, Bisexual, and Transgender (LGBT) People: Building a Foundation for Better UnderstandingWashington, DCNational Academies Press2011www.nap.edu/catalog.php?record_id=13128July62011. 13. Committee on Lesbian, Gay, Bisexual, and Transgender Health Issues and Research Gaps and Opportunities; Board on the Health of Select Populations; Institute of Medicine: The Health of Lesbian, Gay, Bisexual, and Transgender (LGBT) People: Building a Foundation for Better Understanding. Washington, DC: National Academies Press, 2011. www.nap.edu/catalog.php?record_id=13128 (accessed July 6, 2011).
14.
U.S. Department of Health and Human Services: Affordable Care Act to improve data collection, reduce health disparities. News releaseJune292011www.hhs.gov/news/press/2011pres/06/20110629a.htmlJuly262013. 14. U.S. Department of Health and Human Services: Affordable Care Act to improve data collection, reduce health disparities. News release. June 29, 2011. www.hhs.gov/news/press/2011pres/06/20110629a.html (accessed July 26, 2013).
15.
Eng TButler W. The Hidden Epidemic: Confronting Sexually Transmitted DiseasesInstitute of Medicine1997www.nap.edu/catalog.php?record_id=5284November232011. 15. Eng T, Butler W (Eds): The Hidden Epidemic: Confronting Sexually Transmitted Diseases. Institute of Medicine, 1997. www.nap.edu/catalog.php?record_id=5284 (accessed November 23, 2011).
16.
Bickley LSzilagyi PBates BBates Guide to Physical Examination and History Taking10thBethesdaLippincott Williams and Wilkins200981-83. 16. Bickley L, Szilagyi P, Bates B: Bates Guide to Physical Examination and History Taking, 10th ed. Bethesda: Lippincott Williams and Wilkins, 2009, pp 81–83.
17.
Makadon HJ. Ending LGBT invisibility in health care: The first step in ensuring equitable careCleve Clin J Med201178220-224. 17. Makadon HJ: Ending LGBT invisibility in health care: The first step in ensuring equitable care. Cleve Clin J Med 2011;78:220–224.
18.
Klitzman RLGreenberg JD. Patterns of communication between gay and lesbian patients and their health care providersJ Homosex20024265-75. 18. Klitzman RL, Greenberg JD: Patterns of communication between gay and lesbian patients and their health care providers. J Homosex 2002;42:65–75.
19.
Berstein KTLiu KLBegier EMKoblin BKarpati AMurrill C. Same-sex attraction disclosure to health care providers among New York City men who have sex with menArch Intern Med20081681458-1464. 19. Berstein KT, Liu KL, Begier EM, Koblin B, Karpati A, Murrill C: Same-sex attraction disclosure to health care providers among New York City men who have sex with men. Arch Intern Med 2008;168:1458–1464.
20.
Cornell University Law School, Legal Information Institute: 42 USC § 300jj–11—Office of the National Coordinator for Health Information Technologywww.law.cornell.edu/uscode/text/42/300jj-11May212013. 20. Cornell University Law School, Legal Information Institute: 42 USC § 300jj–11—Office of the National Coordinator for Health Information Technology. www.law.cornell.edu/uscode/text/42/300jj-11 (accessed May 21, 2013).
21.
HealthIT.gov. Health IT Policy Committeewww.healthit.gov/policy-researchers-implementers/health-it-policy-committeeMay212013. 21. HealthIT.gov. Health IT Policy Committee: www.healthit.gov/policy-researchers-implementers/health-it-policy-committee (accessed May 21, 2013).
22.
Fenway Health Comments on Stage 2 proposed Meaningful Use Guidelines (CMS-0044-P)www.fenwayhealth.org/site/DocServer/Meaningful_Use_Guidelines_Fenway_Health_comment_summary_.pdf?docID=10303May282013. 22. Fenway Health Comments on Stage 2 proposed Meaningful Use Guidelines (CMS-0044-P) www.fenwayhealth.org/site/DocServer/Meaningful_Use_Guidelines_Fenway_Health_comment_summary_.pdf?docID=10303 (accessed May 28, 2013).
23.
Department of Health and Human Services, Centers for Medicare and Medicaid Services: 42 CFR Parts 412, 413 and 495. Medicare and Medicaid Programs; Electronic Health Record Incentive Program-Stage 2. Final RuleFederal Register771712012September4Rules and Regulations. 53968–54162www.regulations.gov/#!documentDetail;D=CMS-2012–0022-1128April172013. 23. Department of Health and Human Services, Centers for Medicare and Medicaid Services: 42 CFR Parts 412, 413 and 495. Medicare and Medicaid Programs; Electronic Health Record Incentive Program-Stage 2. Final Rule. Federal Register. Vol. 77, No. 171. 2012, September 4. Rules and Regulations. 53968–54162. www.regulations.gov/#!documentDetail;D=CMS-2012–0022-1128 (accessed April 17, 2013).
24.
Department of Health and Human Services, Office of the Secretary: 45 CFR Part 170, RIN 0991-AB62. Health Information Technology: Standards, Implementation Specifications, and Certification Criteria for Electronic Health Record Technology, 2014 Edition; Revisions to the Permanent Certification Program for Health Information TechnologyFederal Register771712012September4Rules and Regulations. 54163–54292www.regulations.gov/#!searchResults;rpp=25;po=0;s=gender%252Bidentity%252Band%252For%252Bsexual%252Borientation;fp=true;ns=trueApril172013. 24. Department of Health and Human Services, Office of the Secretary: 45 CFR Part 170, RIN 0991-AB62. Health Information Technology: Standards, Implementation Specifications, and Certification Criteria for Electronic Health Record Technology, 2014 Edition; Revisions to the Permanent Certification Program for Health Information Technology. Federal Register. Vol. 77, No. 171. 2012, September 4. Rules and Regulations. 54163–54292. www.regulations.gov/#!searchResults;rpp=25;po=0;s=gender%252Bidentity%252Band%252For%252Bsexual%252Borientation;fp=true;ns=true (accessed April 17, 2013).
25.
www.lgbthealtheducation.org/July262013. 25. www.lgbthealtheducation.org/ (accessed July 26, 2013).
26.
Bradford JCahill SGrasso CMakadon HHow to Ask About Sexual Orientation and Gender Identity in Clinical SettingsBostonThe Fenway Institute2012. 26. Bradford J, Cahill S, Grasso C, Makadon H: How to Ask About Sexual Orientation and Gender Identity in Clinical Settings. Boston: The Fenway Institute, 2012.
27.
Keatley JGender Identity Data Collection. Center of Excellence for Transgender Health. Part of Makadon H. Clinical Rationale for the Collection of Sexual Orientation and Gender Identity DataPresentation at the National Association of Community Health Centers Policy and Issues ForumMarch212013. Keatley and CETH's original question gives the following options in the first part of the question: What is your current gender identity? Male; Female; TransMale/Transman; TransFemale/Transwoman; Genderqueer; Additional category______; Decline to state. 27. Keatley J: Gender Identity Data Collection. Center of Excellence for Transgender Health. Part of Makadon H. Clinical Rationale for the Collection of Sexual Orientation and Gender Identity Data. Presentation at the National Association of Community Health Centers Policy and Issues Forum, March 21, 2013. Keatley and CETH's original question gives the following options in the first part of the question: What is your current gender identity? Male; Female; TransMale/Transman; TransFemale/Transwoman; Genderqueer; Additional category______; Decline to state.
28.
Alterman E. Meaningful Use March Madness: SO/GI or Bust! Health Information Technology. National Partnership for Women and FamiliesMarch292013www.nationalpartnership.org/site/News2?page=NewsArticle&id=38807April102013. 28. Alterman E: Meaningful Use March Madness: SO/GI or Bust! Health Information Technology. National Partnership for Women and Families, March 29, 2013. www.nationalpartnership.org/site/News2?page=NewsArticle&id=38807 (accessed April 10, 2013).
29.
Bradford JBarrett KHonnold JThe 2000 Census, Same-Sex Households: A User's GuideNew YorkNational Gay and Lesbian Task Force Policy Institute and the Fenway Institute2002. 29. Bradford J, Barrett K, Honnold J: The 2000 Census and Same-Sex Households: A User's Guide. New York: National Gay and Lesbian Task Force Policy Institute and the Fenway Institute, 2002.
30.
Cahill S. The role of antigay family amendments in the 2004 election. In: Defending Same-Sex Marriage, Volume 1:“Separate But Equal” No More: A Guide to the Legal Status of Same-Sex Marriage, Civil Unions, and Other PartnershipsStrasser M.Westport, CTPraeger2007119-140. 30. Cahill S: The role of antigay family amendments in the 2004 election. In: Defending Same-Sex Marriage, Volume 1:“Separate But Equal” No More: A Guide to the Legal Status of Same-Sex Marriage, Civil Unions, and Other Partnerships. Edited by Strasser M. Westport, CT: Praeger, 2007, pp 119–140.
31.
Gates GHow Many People Are Lesbian, Gay, Bisexual, and Transgender?Williams Institute, UCLA2011http://williamsinstitute.law.ucla.edu/wp-content/uploads/Gates-How-Many-People-LGBT-Apr-2011.pdfDecember292011. 31. Gates G: How Many People Are Lesbian, Gay, Bisexual, and Transgender? Los Angeles: Williams Institute, UCLA, 2011. http://williamsinstitute.law.ucla.edu/wp-content/uploads/Gates-How-Many-People-LGBT-Apr-2011.pdf (accessed December 29, 2011).
32.
Pathela PHajat ASchillinger JBlank SSell RMostashari F. Discordance between sexual behavior and self-reported sexual identity: a population-based survey of New York City menAnn Intern Med2006145416-425; Erratum in: Ann Intern Med 2006;145:936. 32. Pathela P, Hajat A, Schillinger J, Blank S, Sell R, Mostashari F: Discordance between sexual behavior and self-reported sexual identity: a population-based survey of New York City men. Ann Intern Med 2006;145:416–425; Erratum in: Ann Intern Med 2006;145:936.
33.
Mayer KHBradford JBMakadon HJStall RGoldhammer HLanders S. Sexual and gender minority health: What we know and what needs to be doneAm J Pub Health200898989-995. 33. Mayer KH, Bradford JB, Makadon HJ, Stall R, Goldhammer H, Landers S: Sexual and gender minority health: What we know and what needs to be done. Am J Pub Health 2008;98:989–995.
34.
Hoffman SPodgurski A. Improving health care outcomes through personalized comparisons of treatment effectiveness based on electronic health recordsJ Law Med Ethics201139425-436. 34. Hoffman S, Podgurski A: Improving health care outcomes through personalized comparisons of treatment effectiveness based on electronic health records. J Law Med Ethics 2011;39:425–436.
35.
Forsyth J. Medical records of 4.9 million exposed in Texas data breach. Reuterswww.reuters.com/assets/print?aid=USTRE78S5JG20110929September292011. 35. Forsyth J: Medical records of 4.9 million exposed in Texas data breach. Reuters. www.reuters.com/assets/print?aid=USTRE78S5JG20110929 (accessed September 29, 2011).
36.
Gupta A. Hackers, breaches and other threats to electronic recordsHealth Data Manage20111954. 36. Gupta A: Hackers, breaches and other threats to electronic records. Health Data Manage 2011;19:54.
37.
Patient Protection and Affordable Care Act; Establishment of Exchanges and Qualified Health Plan. A Proposed Rule by the Health and Human Services Department on 07/15/2011Federal Registerwww.federalregister.gov/articles/2011/07/15/2011–17610/patient-protection-and-affordable-care-act-establishment-of-exchanges-and-qualified-health-plans#p-252September282011Finalized 2012. www.federalregister.gov/regulations/0938-AQ67/establishment-of-exchanges-and-qualified-health-plans-part-i-cms-9989-f- (accessed April 23, 2013). 37. Patient Protection and Affordable Care Act; Establishment of Exchanges and Qualified Health Plan. A Proposed Rule by the Health and Human Services Department on 07/15/2011. Federal Register. www.federalregister.gov/articles/2011/07/15/2011–17610/patient-protection-and-affordable-care-act-establishment-of-exchanges-and-qualified-health-plans#p-252 Accessed September 28, 2011. Finalized 2012. www.federalregister.gov/regulations/0938-AQ67/establishment-of-exchanges-and-qualified-health-plans-part-i-cms-9989-f- (accessed April 23, 2013).
38.
Health and Human Services. Modifications to the HIPAA Privacy, Security, Enforcement, and Breach Notification Rules Under the Health Information Technology for Economic and Clinical Health Act and the Genetic Information Nondiscrimination Act; Other Modifications to the HIPAA Rules. Federal RegisterJanuary252013https://www.federalregister.gov/articles/2013/01/25/2013-01073/modifications-to-the-hipaa-privacy-security-enforcement-and-breach-notification-rules-under-theJuly262013. 38. Health and Human Services. Modifications to the HIPAA Privacy, Security, Enforcement, and Breach Notification Rules Under the Health Information Technology for Economic and Clinical Health Act and the Genetic Information Nondiscrimination Act; Other Modifications to the HIPAA Rules. Federal Register. January 25, 2013. https://www.federalregister.gov/articles/2013/01/25/2013-01073/modifications-to-the-hipaa-privacy-security-enforcement-and-breach-notification-rules-under-the (accessed July 26, 2013).
39.
Lambda Legal: When Health Care Isn't Caring: Lambda Legal's Survey of Discrimination Against LGBT People and People with HIVNew YorkLambda Legal2010www.lambdalegal.org/health-care-reportJuly262013. 39. Lambda Legal: When Health Care Isn't Caring: Lambda Legal's Survey of Discrimination Against LGBT People and People with HIV. New York: Lambda Legal, 2010. www.lambdalegal.org/health-care-report (accessed July 26, 2013).
40.
Smith DMMathews WC. Physicians' attitudes toward homosexuality and HIV: Survey of a California medical society-revisited (PATHH-II)J Homosex2007521-9. 40. Smith DM, Mathews WC: Physicians' attitudes toward homosexuality and HIV: Survey of a California medical society-revisited (PATHH-II). J Homosex 2007;52:1–9.
41.
National Gay and Lesbian Task Force: State nondiscrimination laws in the U.SLast updatedJanuary202012www.thetaskforce.org/downloads/reports/issue_maps/non_discrimination_1_12.pdfSeptember172012. 41. National Gay and Lesbian Task Force: State nondiscrimination laws in the U.S. Last updated January 20, 2012. www.thetaskforce.org/downloads/reports/issue_maps/non_discrimination_1_12.pdf (accessed September 17, 2012).
42.
Cianciotto JCahill SLGBT Youth in America's SchoolsAnn ArborUniversity of Michigan Press201263-65. 42. Cianciotto J, Cahill S: LGBT Youth in America's Schools. Ann Arbor: University of Michigan Press, 2012, pp 63–65.
43.
Rosenbaum SEssential Health Benefits Update: Proposed Regulations Implementing the ACA; and Application of the Proposed EHB Regulations to Medicaid Benchmark Plans. Health Reform GPS. George Washington University's Hirsh Health Law and Policy Program and the Robert Wood Johnson FoundationNovember292012http://healthreformgps.org/resources/essential-health-benefits-update-proposed-regulations-implementing-the-aca-and-application-of-the-proposed-ehb-regulations-to-medicaid-benchmark-plans/March122013. 43. Rosenbaum S: Essential Health Benefits Update: Proposed Regulations Implementing the ACA; and Application of the Proposed EHB Regulations to Medicaid Benchmark Plans. Health Reform GPS. George Washington University's Hirsh Health Law and Policy Program and the Robert Wood Johnson Foundation. November 29, 2012. http://healthreformgps.org/resources/essential-health-benefits-update-proposed-regulations-implementing-the-aca-and-application-of-the-proposed-ehb-regulations-to-medicaid-benchmark-plans/(accessed March 12, 2013).
44.
Obedin-Maliver JGoldsmith ESStewart LWhite WTran EBrenman SWells MFetterman DMGarcia GLunn MR. Lesbian, gay, bisexual and transgender-related content in undergraduate medical educationJAMA2011306971-977. 44. Obedin-Maliver J, Goldsmith ES, Stewart L, White W, Tran E, Brenman S, Wells M, Fetterman DM, Garcia G, Lunn MR: Lesbian, gay, bisexual and transgender-related content in undergraduate medical education. JAMA 2011;306:971–977.
45.
The Fenway Institute, Center for American Progress, et al. Community public comment on Stage 3 proposed Meaningful Use Guidelines submitted to Office of the National Coordinator of Health Information Technology and Center for Medicare and Medicaid ServicessubmittedJanuary142013www.fenwayhealth.org/site/DocServer/Stage_3_Meaningful_Use_Guidelines_community_comments_Jan.pdf?docID=10822May282013. 45. The Fenway Institute, Center for American Progress, et al.: Community public comment on Stage 3 proposed Meaningful Use Guidelines submitted to Office of the National Coordinator of Health Information Technology and Center for Medicare and Medicaid Services; submitted January 14, 2013. www.fenwayhealth.org/site/DocServer/Stage_3_Meaningful_Use_Guidelines_community_comments_Jan.pdf?docID=10822 (accessed May 28, 2013).
46.
Grant JMottet LTanis JInjustice at Every Turn: A Report of the National Transgender Discrimination SurveyWashington, DCNational Center for Transgender Equality and National Gay and Lesbian Task Force2011. 46. Grant J, Mottet L, Tanis J: Injustice at Every Turn: A Report of the National Transgender Discrimination Survey. Washington, DC: National Center for Transgender Equality and National Gay and Lesbian Task Force, 2011.
47.
Ponce NCochran SPizer JMays V. The effects of unequal access to health insurance for same-sex couples in CaliforniaHealth Aff2010291539-1548. 47. Ponce N, Cochran S, Pizer J, Mays V: The effects of unequal access to health insurance for same-sex couples in California. Health Aff 2010;29:1539–1548.
Information & Authors
Information
Published In
Copyright
Copyright 2014, Mary Ann Liebert, Inc.
History
Published in print: March 2014
Published online: 5 September 2013
Published ahead of print: 2 August 2013
Topics
Authors
Author Disclosure Statement
No competing financial interests exist.
Metrics & Citations
Metrics
Citations
Export Citation
Export citation
Select the format you want to export the citations of this publication.
View Options
Access content
To read the fulltext, please use one of the options below to sign in or purchase access.⚠ Society Access
If you are a member of a society that has access to this content please log in via your society website and then return to this publication.