TREATMENT OUTCOMES FOR ABUSED WOMEN IN PUBLIC CLINICS

这项为期4年的随机对照试验将设计、实施和测试护士病例管理和群体教育对在内城初级保健诊所就诊的非洲裔美国人、西班牙裔和白人受虐妇女的效果。这些诊所是全县系统的一部分，该系统维护着一个住院和门诊病人接触的计算机信息系统。以理论为基础的干预措施将建立在经过经验检验的组成部分，旨在：增加安全规划行为；提高安全行为的自我效能感；减少虐待的频率和严重程度；改善身体、情绪和社交健康；减少计划外医疗服务的利用；提高工作效率。另一个目标是评估干预措施对受虐待妇女子女的健康和功能状况以及医疗利用的影响。将对前来就医的18-44岁妇女进行连续抽样，以检查是否存在家庭暴力，直到获得400名受虐待妇女的抽样。在析因设计中，参与者将随机分配到4个治疗单元中的一个：转诊卡、转诊卡+小组教育、转诊卡+病例管理、转诊卡+小组教育+病例管理。护士病例管理将包括安全规划、危机管理、支持性护理、预期指导和转诊方面的教育。团体教育将由地方法律、社会和教育机构为受虐待妇女举办的会议组成。析因研究设计将允许测试群体教育和护士病例管理的主要效果，以及群体教育和病例管理对安全行为、妇女及其子女的健康结果和医疗保健利用的相互作用。将在基线和随机分组后的3年内每6个月收集一次测量数据。将从社会和卫生保健系统的角度对四种替代疗法进行成本效益分析，对该计划进行经济评估。

This 4-year randomized controlled trial will design, implement, and test the efficacy of nurse case management and group education for African- American, Hispanic, and White abused women attending inner city primary care clinics. These clinics are part of a county-wide system that maintains a computerized information system of inpatient and outpatient encounters. The theoretically-based intervention will build on empirically tested components designed to: increase safety planning behaviors; increase self-efficacy for safety behaviors; decrease frequency and severity of abuse; improve physical emotional and social well-being; decrease unscheduled medical care utilization; and increase work productivity. An additional objective is to evaluate the impact of the interventions on the health and functional status and medical utilization of abused women's children. Consecutive sampling of women 18-44 years of age presenting for medical care will be screened for domestic violence until a sample of 400 abused women is obtained. Participants will be randomized to one of 4 treatment cells in a factorial design: referral card, referral card + group education, referral card + case management, referral card + group education + case management. Nurse case management will include education on safety planning, crisis management, supportive care, anticipatory guidance, and referrals. Group education will consist of sessions conducted by local legal, social, and educational agencies for abused women. The factorial study design will allow testing the main effects of group education and nurse case management and the interaction of group education and case management on safety behaviors, health outcomes in the women and their children, and medical care utilization. Measures will be collected at baseline and every 6 months for 3 years after randomization. An economic evaluation of the program will be conducted using cost benefit analyses of the four alternative treatments from both societal and health care system perspectives.