DOMESTIC VIOLENCE IDENTIFICATION: OUTCOMES/EFFECTIVENESS

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Significance: Domestic violence (DV) is a common health problem resulting in immediate injury and/or long-term chronic medical conditions (e.g., depression and various pain syndromes) making it a major national healthcare issue. Providers have not been trained to identify and manage DV. Affective barriers to intervention by providers are significant. Approaches directed to the whole healthcare team and the practice infrastructure hold the most promise for improving DV identification and management. OBJECTIVE: To assess the effectiveness of a DV identification and management program directed to the whole healthcare team. SITE: Four outpatient clinics at Group Health Cooperative of Puget Sound. SUBJECTS: Primary care providers (an average of 55 staff per clinic; 220 in proposed study); adult enrollees (an average of 20,281 per clinic; 81,124 in four study sites). INTERVENTION: Two clinics will receive an intensive intervention directed to the whole healthcare team and the practice infrastructure. Two other clinics will serve as a comparison group. EVALUATION DESIGN: A randomized clinical trial in four clinics with effects measured during a baseline and a follow-up period. Intra- and inter-clinic comparisons of changes in outcomes 1-5 below will be made. DATA COLLECTION: Automated treatment recording forms, followed by medical record review for validation; provider surveys at time T1 and time T2; focus groups at time T2. MAIN OUTCOME MEASURES: 1) provider knowledge, attitudes and beliefs about identification and management of DV; 2) recorded rate of questioning for DV among high risk and routine physical exam patients; 3) the proportion of DV cases with specific management plans recorded; 4) the incidence of injuries and selected chronic medical conditions due to DV; 5) incidence of DV recurrence; 6) delineation of the perceived effectiveness and costs of the component parts of the intervention; and 7) description of the patterns of medical care utilization and costs for DV victims and comparison of these to a population-based control group. MAJOR STUDY BENEFITS: First DV study we know of directed to whole primary care team changes in multiple outcomes, including recurrence rates, will be assessed; rates of DV injuries and selected chronic medical conditions obtained; components of the intervention are assessed; and utilization and costs of DV care will be measured.