DOMESTIC VIOLENCE IDENTIFICATION: OUTCOMES/EFFECTIVENESS

家庭暴力（DV）是一种常见的健康问题， 在直接损伤和/或长期慢性医学病症中（例如， 抑郁症和各种疼痛综合征），使其成为一个主要的国家 保健问题。提供者没有接受过识别和管理 DV。提供者干预的情感障碍很大。 针对整个医疗团队和实践的方法 基础设施最有希望改善DV识别， 管理 目的：评估家庭暴力鉴定的有效性， 管理方案针对整个医疗团队。 地点：普吉湾团体健康合作社的四个门诊诊所。 对象：初级保健提供者（平均每个诊所55名工作人员; 220名 在拟议的研究中）;成人入组者（平均每家诊所20，281人; 81，124人（4个研究中心）。 干预：两个诊所将接受强化干预， to the whole整个healthcare医疗team团队and the practice实践infrastructure基础设施.另外两 诊所将作为对照组。 评价设计：一项在四个诊所进行的随机临床试验， 在基线和随访期间测量的效果。内和 将对以下结局1 - 5的变化进行诊所间比较。 数据收集：自动化治疗记录表，然后是医疗记录表。 在时间T1和时间T2处的提供者调查; 时间点T2的焦点小组。 主要观察指标：1）提供者对 家庭暴力的识别和管理; 2）记录询问率， 高危人群和常规体检人群中DV的比例 的家庭暴力个案有具体的管理计划; 4） 家庭暴力造成的伤害和某些慢性疾病; 5）发病率 家庭暴力复发率; 6）描述感知的有效性和成本 干预的组成部分;和7）描述 家庭暴力受害者的医疗保健利用模式和费用， 将其与基于人口的对照组进行比较。 主要研究受益：我们所知的第一项针对整个小学的DV研究 护理团队在多个结局方面的变化，包括复发率， 家庭暴力伤害率和选定的慢性疾病 获得;评估干预措施的组成部分;利用和 家庭暴力护理的成本将被衡量。

Significance: Domestic violence (DV) is a common health problem resulting in immediate injury and/or long-term chronic medical conditions (e.g., depression and various pain syndromes) making it a major national healthcare issue. Providers have not been trained to identify and manage DV. Affective barriers to intervention by providers are significant. Approaches directed to the whole healthcare team and the practice infrastructure hold the most promise for improving DV identification and management. OBJECTIVE: To assess the effectiveness of a DV identification and management program directed to the whole healthcare team. SITE: Four outpatient clinics at Group Health Cooperative of Puget Sound. SUBJECTS: Primary care providers (an average of 55 staff per clinic; 220 in proposed study); adult enrollees (an average of 20,281 per clinic; 81,124 in four study sites). INTERVENTION: Two clinics will receive an intensive intervention directed to the whole healthcare team and the practice infrastructure. Two other clinics will serve as a comparison group. EVALUATION DESIGN: A randomized clinical trial in four clinics with effects measured during a baseline and a follow-up period. Intra- and inter-clinic comparisons of changes in outcomes 1-5 below will be made. DATA COLLECTION: Automated treatment recording forms, followed by medical record review for validation; provider surveys at time T1 and time T2; focus groups at time T2. MAIN OUTCOME MEASURES: 1) provider knowledge, attitudes and beliefs about identification and management of DV; 2) recorded rate of questioning for DV among high risk and routine physical exam patients; 3) the proportion of DV cases with specific management plans recorded; 4) the incidence of injuries and selected chronic medical conditions due to DV; 5) incidence of DV recurrence; 6) delineation of the perceived effectiveness and costs of the component parts of the intervention; and 7) description of the patterns of medical care utilization and costs for DV victims and comparison of these to a population-based control group. MAJOR STUDY BENEFITS: First DV study we know of directed to whole primary care team changes in multiple outcomes, including recurrence rates, will be assessed; rates of DV injuries and selected chronic medical conditions obtained; components of the intervention are assessed; and utilization and costs of DV care will be measured.