Violence against women in the US is a serious public health problem and a human rights issue. The U.S. Bureau of Justice Statistics reports that 22% of violent crimes against women are accounted for by Intimate Partner Violence (IPV). IPV screening recommendations support universal screening to include all women and not only those with obvious signs of physical abuse. However, the overall prevalence of screening for intimate partner violence (IPV) in health care settings is still low. Moreover, evidence on the effectiveness of screening programs are conflicting. Recent studies indicates that, while screening increases the rate of identification of IPV, it has not been shown to increase rates of referral for IPV counseling or improve health outcomes. Evidence also indicates that effective IPV screening programs are those with a ?systems level? approach to design and implementation. The lack of compelling evidence on the effectiveness of IPV screening programs might be related to lack of the system level changes required for such programs to succeed. This study aims to fill the knowledge gap by designing, implementing and evaluating a health system level intervention through EHR modifications to improve IPV care. The proposed intervention includes several elements: tools and decision support for screening and detection of IPV, referral to national IPV counseling resource via telephone/telehealth and EHR modifications to support safe billing for IPV services. For screening and detection of IPV cases, the intervention focuses on routine inquiry by EHR embedded self-reported questionnaires and by an automated analysis of past records. These two sources are considered complementary to support providers with data to make timely decision about IPV diagnosis and subsequent referral. The two aims are carefully designed to accomplish all elements of the study;
Aim 1 focuses on developing an EHR-based decision support system for screening, diagnosis, referral and handoff of IPV care to a helpline. The system will use self-reported questionnaires as a routine tool to screen and detect IPV cases.
Aim2 focuses on implementing this decision support system through a stepped wedge cluster randomized design across 28 primary care clinics- family medicine, internal medicine and gynecology. The impact of the intervention will be measured by comparing rates of diagnosis of IPV and referral of women for counseling services under the newly developed system to those reported under usual care. The impact on provider productivity and reimbursements will also be measured. If shown to be effective, it is our intention that the IPV tools created under this effort could become part of the base Epic system distributed by the manufacturer, and hence integrated into the EHRs to care 190 million patients across the US.
Intimate partner violence (IPV) against women in the US is a serious public health problem and a human rights issue. Evidence on the effectiveness of IPV screening programs are conflicting; while screening seem to increases the rate of identification of IPV, it has not been shown to increase rates of referral for IPV counseling or improve health outcomes. This study aims to fill the knowledge gap by designing, implementing and evaluating a health system level intervention through EHR modifications to improve IPV care.
