A RCT OF COMPUTER SCREENING FOR DOMESTIC VIOLENCE

家庭暴力受害者经常到急诊科求医，而卫生保健提供者有机会发现家庭暴力并进行干预。不幸的是，由于时间压力和问题的敏感性，急诊科人员经常不进行DV筛查。需要新的方法来提高对急诊科的检测和干预。我们开发并试点了一种自我管理的计算机健康风险评估（ED prevention），由患者在急诊科就诊前完成。高危行为被提供给急诊科医生。我们的试验表明，与对照组（1个图表说明）相比，接受ED预防治疗的患者的医生在DV图表文档（19个DV图表说明）方面有显著改善。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DV沟通的影响。800名女性患者在两个不同的急诊科就诊（一个主要是非裔美国人的城市急诊科和一个主要是高加索人的郊区社区急诊科），随机分为急诊科预防组和普通护理组。所有的访问都将被录音。研究的主要结果将是患者披露和医生/护士基于录音带讨论家庭暴力。次要结果包括患者对家庭暴力服务的了解或接触，患者对与急诊科工作人员沟通的满意度，以及家庭暴力的图表记录。ED预防对披露率和讨论率的影响将采用logistic回归控制医院地点和患者人口统计学进行评估。除了定性分析将探索ED防止DV沟通的影响变量(如讨论的时间和起始DV和ED提供者/病人情感反应]这项研究有可能为其提供一种全新的方法依赖于电脑屏幕的女性而不是一个繁忙的医生和潜在医生的角色转向讨论和推荐,最终改善女性的可能性将改变的情况。研究结果可以推广到许多其他不同人群的ed。此外，这些数据将可用于未来调查ED的通信。

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.