DOMESTIC VIOLENCE IDENTIFICATION: OUTCOMES/EFFECTIVENESS

意义：家庭暴力是一种常见的健康问题 在直接受伤和/或长期慢性医疗条件下(例如， 抑郁症和各种疼痛综合症)使其成为一个主要的国家 医疗保健问题。供应商没有接受过识别和管理的培训 DV。提供者进行干预的情感障碍是很大的。 针对整个医疗团队和实践的方法 基础设施最有希望改善DV识别和 管理层。 目的：评价DV的鉴定和鉴定的有效性。 针对整个医疗团队的管理计划。 网站：普吉特湾团体卫生合作社的四家门诊。 对象：初级保健提供者(每个诊所平均有55名工作人员；220人 成人参与者(平均每个诊所20,281人； 四个研究地点的81,124个)。 干预：两家诊所将接受定向强化干预 到整个医疗团队和实践基础设施。另外两个 诊所将作为对照组。 评价设计：一项在四个诊所进行的随机临床试验 在基线和随访期内测量的效果。内部和 下面将对结果1-5的变化进行临床间比较。 数据收集：自动治疗记录表，然后是医疗 记录评审以进行验证；供应商在时间t1和时间t2进行调查； 时间t2的焦点小组。 主要观察指标：1)提供者关于以下方面的知识、态度和信念 DV的识别和管理；2)记录的质问率 DV在高危和常规体检患者中的比例 有特定管理计划的DV病例的发生率；4) DV造成的伤害和选定的慢性疾病；5)发病率 DV复发；6)描述感知的有效性和成本 干预措施的构成部分；以及7)对 登革热患者的医疗服务利用和费用模式 将其与以人群为基础的控制组进行比较。 主要研究好处：我们所知的第一个针对整个小学的DV研究 护理团队在多个结果中的变化，包括复发率，将 接受评估；DV伤害率和选定的慢性疾病 获得；评估干预措施的组成部分；以及利用和 将衡量DV护理的成本。

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.