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

解决女性退伍军人中的亲密伴侣暴力问题：评估 VHA 应对措施的影响和有效性。

• 批准号: 10051326
• 负责人: Katherine M Iverson
• 金额: --
• 依托单位: VA BOSTON HEALTH CARE SYSTEM
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-11-01 至 2023-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10051326
• 关键词: Abnormal coordination; Academy; Address; Adoption; Advisory Committees; Area; Caring; Clinic; Clinical; Clinical effectiveness; Community Services; Counseling; Data; Data Analyses; Data Collection; Disclosure; Economics; Effectiveness; Evaluation; Evidence based practice; Forcible intercourse; Funding; Future; Gender; Health; High Prevalence; Hybrids; Improve Access; Intervention; Interview; Life; Maintenance; Medicine; Mental Health; Mental Health Services; Methodology; Methods; Modeling; Morbidity - disease rate; Patient Care; Patients; Phase; Population Heterogeneity; Preventive service; Primary Health Care; Process; Program Evaluation; Promoting Action on Research Implementation in Health Services framework; Provider; Psyche structure; Psychiatric Social Work; Psychosocial Assessment and Care; Randomized; Reach, Effectiveness, Adoption, Implementation, and Maintenance; Recommendation; Records; Research; Resources; Savings; Screening procedure; Services; Site; Social Work; Specific qualifier value; Suicide; Suicide prevention; Surveys; Testing; Time; Training; United States; Veterans; Veterans Health Administration; Violence; Visit; Woman; Women' s Health; Women' s Health Services; clinical practice; compare effectiveness; design; effectiveness outcome; experience; health care service; health service use; implementation barriers; implementation fidelity; implementation outcomes; implementation science; implementation strategy; improved; informant; innovation; interest; intimate partner violence; operation; physical conditioning; population health; programs; response; routine screening; screening; screening guidelines; screening program; social; suicidal risk; telephone coaching; uptake; virtual

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.

背景：亲密伴侣暴力（IPV）在女退伍军人（WVS）中很常见，近20％ 在退伍军人卫生管理局（VHA）的初级保健诊所接受过的WVS治疗，经历了过去一年的IPV。 vha的 妇女保健服务（WHS），IPV援助计划以及初级保健和精神的办公室 健康和自杀预防制定了针对实施IPV筛查计划的建议 初级保健。超过三分之二的WV初级保健患者在“模型1”中获得护理（即混合性别 初级保健）和“模型2”（即单独但共享的空间）诊所，但筛查的吸收很低 诊所。因此，WH计划使用混合促进（BF）在模型1和 模型2初级保健诊所。鉴于整个VHA的这些诊所数量很大，尚不清楚是否是否 资源密集型的BF是可行的，以及是否较少密集的策略（即工具包 +像往常一样实施 [iau]）可以有效。还需要研究IPV筛查计划的临床有效性。 意义/影响：鉴于WVS之间IPV的高度及其显着的健康影响， 预计成功实施IPV筛查计划将改善医疗服务并减少 WV VHA患者的发病率，HSR＆D优先区域。 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。它包括四个强VHA，具有创新性 运营合作伙伴致力于成功实施IPV筛选程序。这个项目 利用时间敏感的机会来推进IPV筛选计划和实施科学。 具体目的：该提案的这个目标是全面评估实施的两种策略 通过实现三个特定目标，IPV筛选程序。 （1）评估覆盖率，采用程度， 实施保真度和使用两种实施策略进行IPV筛选实现的维护 程序。 （2）评估IPV筛查计划的临床有效性，如披露率所证明 和筛查后的社会心理服务使用。 （3）确定IPV筛选的多层次障碍和促进者 计划实施和维持。 方法论：我们提出了一个随机的簇，阶梯楔，混合II型程序评估设计 比较两种实施策略（BF +工具包与工具包 + IAU）和临床的影响 IPV筛选程序的有效性。我们提出了一种混合方法来收集定量 （临床记录数据）和定性（主要线人访谈）实施结果（目标1和3）， 以及定量（临床记录数据）临床有效性结果（AIM 2）。我们将补充这些 与评估实施策略调查的数据收集方法将在BF之前完成， BF后以及维护阶段。对研究实施的集成促进行动 卫生服务（I-Parihs）框架将指导定性数据收集和分析。总结数据 将使用触及效率采用实施维护（RE-AIM）框架进行分析。 下一步/实施：我们的四个VHA操作合作伙伴渴望使用我们的研究结果告知 未来的实施策略和临床实践，将IPV筛选程序传播到所有VHA主要 护理诊所和其他临床环境，因此所有WV VHA患者都可以接受这种重要干预措施。