Addressing Intimate Partner Violence Among Women Veterans: Evaluating the Impact and Effectiveness of VHA's Response.

背景：亲密伴侣暴力(IPV)在女性退伍军人中很常见，近20%的 WVS在退伍军人健康管理局(VHA)初级保健诊所接受治疗，经历了过去一年的IPV。VHA的 妇女保健服务(WHS)、IPV援助方案以及初级保健和精神保健办公室 健康和自杀预防为实施IPV筛查计划制定了建议 初级保健。超过2/3的WV初级保健患者在“模式1”(即混合性别)中接受护理 初级保健)和“模式2”(即分开但共用空间)诊所，但这些诊所对筛查的接受率较低 诊所。因此，WHS计划使用混合促进(BF)在模式1和 模式2初级保健诊所。鉴于VHA各地此类诊所的数量很多，目前尚不清楚 资源密集型高炉是否可行，以及是否采取不那么密集的战略(即工具包+照常实施 [IAU])可能是有效的。还需要对IPV筛查计划的临床有效性进行研究。 意义/影响：鉴于传染性支气管炎在世界卫生组织中的高流行率及其对健康的重大影响， IPV筛查计划的成功实施有望改善医疗服务并减少 WV VHA患者的发病率，这是HSR&D的优先领域。 创新：这项研究将是对实施影响和 全球IPV筛查计划的临床有效性。它的创新之处在于它包含了四个强大的VHA 致力于成功实施IPV筛查计划的运营合作伙伴。这个项目 利用时间敏感的机会推进IPV筛查计划和实施科学。 具体目标：本提案的这一目标是全面评估实施以下两项战略 IPV筛查方案通过实现三个具体目标。(1)评估可及程度、采用程度、 使用IPV筛查的两种实施策略实现实施保真度和维护 程序。(2)评估IPV筛查计划的临床效果，如披露率所证明的 和筛查后的心理社会服务使用情况。(3)确定IPV筛查的多层次障碍和促进者 计划的实施和维持。 方法：我们提出了一种整群随机、阶梯式楔形、混合型II方案评估设计 比较两种实施策略(BF+TOOLKIT与TOOLKIT+IAU)的影响以及临床 IPV筛查计划的有效性。我们提出了一种混合方法来收集定量数据 (临床记录数据)和定性(关键信息提供人访谈)执行成果(目标1和3)，如 以及量化(临床记录数据)临床效果结果(目标2)。我们将对这些进行补充 数据收集方法和评估实施战略的调查应在高炉前完成， 高炉后，处于维护阶段。年研究实施的综合促进行动 卫生服务(I-PARIHS)框架将指导定性数据的收集和分析。总结性数据 将使用REACH有效性采用实施维护(RE-AIM)框架进行分析。 下一步/实施：我们的四个VHA运营合作伙伴渴望使用我们的研究结果来告知 未来的实施战略和临床实践，将IPV筛查计划推广到所有VHA初级医院 护理诊所和其他临床环境，以便所有WV VHA患者都能获得这一重要干预措施。

Background: Intimate partner violence (IPV) is common among women Veterans (WVs), with nearly 20% of WVs treated in Veterans Health Administration (VHA) primary care clinics experiencing past-year IPV. VHA’s Women’s Health Services (WHS), the IPV Assistance Program, and the Offices of Primary Care and Mental Health and Suicide Prevention developed recommendations for implementing IPV screening programs in primary care. More than two-thirds of WV primary care patients receive care in “Model 1” (i.e., mixed-gender primary care) and “Model 2” (i.e., separate but shared space) clinics, but uptake of screening is low in these clinics. WHS therefore plans to use Blended Facilitation (BF) to roll out IPV screening programs in Model 1 and Model 2 primary care clinics. Given the high number of these clinics throughout VHA, it is unclear whether resource-intensive BF is feasible and whether a less intensive strategy (i.e., toolkit + Implementation as Usual [IAU]) can be effective. Research is also needed on the clinical effectiveness of IPV screening programs. Significance/Impact: Given the high prevalence of IPV among WVs and its significant health effects, successful implementation of IPV screening programs is expected to improve healthcare services and reduce morbidity among WV VHA patients, an HSR&D priority area. Innovation: This study will be the most comprehensive evaluation of both the implementation impact and clinical effectiveness of IPV screening programs globally. It is innovative in its inclusion of four strong VHA operations partners dedicated to successful implementation of IPV screening programs. This project capitalizes on a time-sensitive opportunity to advance IPV screening programs and implementation science. Specific Aims: This objective of this proposal is to comprehensively evaluate two strategies for implementing IPV screening programs through achieving three specific aims. (1) Evaluate the degree of reach, adoption, implementation fidelity, and maintenance achieved using two implementation strategies for IPV screening programs. (2) Evaluate the clinical effectiveness of IPV screening programs, as evidenced by disclosure rates and post-screening psychosocial service use. (3) Identify multi-level barriers to and facilitators of IPV screening program implementation and sustainment. Methodology: We propose a cluster randomized, stepped wedge, Hybrid Type II program evaluation design to compare the impact of two implementation strategies (BF + toolkit vs. toolkit + IAU) and the clinical effectiveness of IPV screening programs. We propose a mixed methods approach to collect quantitative (clinical records data) and qualitative (key informant interviews) implementation outcomes (Aims 1 and 3), as well as quantitative (clinical records data) clinical effectiveness outcomes (Aim 2). We will supplement these data collection methods with surveys to assess implementation strategies survey to be completed pre-BF, post-BF, and in the maintenance phase. The integrated-Promoting Action on Research Implementation in Health Services (i-PARIHS) framework will guide the qualitative data collection and analysis. Summative data will be analyzed using the Reach Effectiveness Adoption Implementation Maintenance (RE-AIM) Framework. Next Steps/Implementation: Our four VHA operations partners are eager to use our study results to inform future implementation strategies and clinical practices to spread IPV screening programs to all VHA primary care clinics and other clinical settings so that this vital intervention is accessible to all WV VHA patients.