A RCT OF COMPUTER SCREENING FOR DOMESTIC VIOLENCE

家庭暴力受害者经常到急诊科就医，医疗保健提供者有机会发现DV并进行干预。不幸的是，由于时间压力和问题的敏感性，急诊科人员经常不对DV进行筛查。需要新的方法来改进对ED的检测和干预。我们开发并试行了一种自我管理的计算机健康风险评估(ED预防)，由患者在就诊ED之前完成。高危行为被提供给急诊医生。与对照组(1个图表注释)相比，接受ED预防的患者(19个DV图表注释)的医生的DV图表文档显著改善。本研究是一项随机对照试验，旨在测试ED预防对医生/护士与患者之间关于DV的沟通的影响。800名女性患者被随机分配到两个不同的急诊室(一个是市区ED，患者主要是非裔美国人，另一个是郊区社区的ED，患者主要是高加索人)，将被随机分为预防ED组或常规护理组。所有的探访都将被录音。这项研究的主要结果将是根据录音带披露患者情况和医生/护士对DV的讨论。次要结果将包括患者对DV服务的了解或接触、患者对与急诊工作人员沟通的满意度以及DV的图表记录。通过对医院场地和患者人口统计资料进行Logistic回归控制，评估ED预防对公开和讨论率的影响。此外，定性分析将探索ED预防对DV沟通变量的影响[例如，关于DV和ED提供者/患者情感反应的讨论的时间和开始]这项研究有可能提供一种新的方法，依靠计算机而不是忙碌的医生来筛查急诊室的女性，并潜在地将医生的角色转变为讨论和转介，最终提高女性改变虐待情况的可能性。研究结果可以推广到其他许多不同人群的ED。此外，有关资料将可供日后在教育署进行通讯调查之用。

Victims of domestic violence frequently seek medical care in emergency departments (EDs) and health care providers have the opportunity to detect DV and intervene. Unfortunately ED personnel often do not screen for DV due to time pressures and the sensitive nature of the problem. Novel methods are needed to improve detection and intervention in the ED. We developed and piloted a self-administered computer health risk assessment (ED Prevent) that is completed by patients before their ED visit. High-risk behaviors are provided to the ED physician. Our pilot demonstrated significant improvement in the chart documentation of DV by physicians in patients receiving ED Prevent (19 chart notes of DV) compared to controls (1 chart note).This study is a randomized control trial to test the effect of ED Prevent on the communication between physicians/nurses and patients about DV. 800 women patients presenting to two different EDs (a urban ED with largely African American patients and a suburban community ED with mainly Caucasian patients) will be randomized to either ED Prevent or Usual Care. All visits will be audio-taped. Primary outcomes for the study will be patient disclosure and physician/nurse discussion of DV based on the audio-tapes. Secondary outcomes will include patient knowledge of, or contact with, DV services, patient satisfaction with communication with ED staff, and chart documentation of DV. The effect of ED Prevent on rates of disclosure and discussion will be evaluated using logistic regression controlling for hospital site and patient demographics. In addition a qualitative analysis will explore the effect of ED Prevent on DV communication variables [such as the timing and initiation of discussions about DV and ED provider/patient affective responses] The study has the potential to provide a novel way to screen women in the ED relying on a computer instead of a busy physician and potentially shifting the role of the physician to discussion and referral, ultimately improving the likelihood that women will change the abusive situation. The study results may be generalizable to many other EDs with a variety of populations. Further the data will be available for future investigations of communication in the ED.