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) 在女性退伍军人 (WV) 中很常见，近 20% 在退伍军人健康管理局 (VHA) 初级保健诊所接受治疗的、经历过去年 IPV 的 WV。 VHA 的 妇女健康服务 (WHS)、IPV 援助计划以及初级保健和心理办公室 健康和自杀预防制定了在以下地区实施 IPV 筛查计划的建议 初级保健。超过三分之二的西弗吉尼亚州初级保健患者接受“模式 1”（即混合性别 初级保健）和“模式 2”（即独立但共享空间）诊所，但这些诊所的筛查率较低 诊所。因此，WHS 计划使用混合促进 (BF) 来推出模式 1 和模式 1 中的 IPV 筛查计划 模式 2 初级保健诊所。鉴于 VHA 内此类诊所数量众多，尚不清楚是否 资源密集型 BF 是否可行，以及是否采用不太密集的策略（即工具包 + 照常实施） [IAU]）可能是有效的。还需要研究 IPV 筛查项目的临床有效性。 意义/影响：鉴于 IPV 在 WV 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预计将改善医疗保健服务并减少 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影响的最全面的评估 全球 IPV 筛查项目的临床有效性。它的创新之处在于包含四个强大的 VHA 致力于成功实施 IPV 筛查计划的运营合作伙伴。这个项目 利用时间紧迫的机会推进 IPV 筛查计划和实施科学。 具体目标：本提案的目标是全面评估实施这两项战略 IPV 筛查计划通过实现三个具体目标。 (1) 评估影响范围、采用程度、 使用两种 IPV 筛查实施策略实现实施保真度和维护 程序。 (2) 评估 IPV 筛查计划的临床有效性，如披露率所示 和筛查后心理社会服务的使用。 (3) 识别 IPV 筛查的多层次障碍和促进因素 计划的实施和维持。 方法：我们提出了一种集群随机、阶梯楔形、混合 II 类项目评估设计 比较两种实施策略（BF + 工具包与工具包 + IAU）的影响和临床效果 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（关键知情人访谈）实施结果（目标 1 和 3），如 以及定量（临床记录数据）临床有效性结果（目标 2）。我们会补充这些 数据收集方法和评估实施策略的调查在BF前完成， BF后和维持阶段。科研实施一体化推进行动 卫生服务（i-PARIHS）框架将指导定性数据收集和分析。汇总数据 将使用影响力有效性采用实施维护 (RE-AIM) 框架进行分析。 后续步骤/实施：我们的四个 VHA 运营合作伙伴渴望利用我们的研究结果来告知 未来的实施策略和临床实践，将 IPV 筛查计划推广到所有 VHA 小学 护理诊所和其他临床环境，以便所有西弗吉尼亚州 VHA 患者都能获得这一重要干预措施。