TREATMENT OUTCOMES FOR ABUSED WOMEN IN PUBLIC CLINICS

这项为期4年的随机对照试验将设计、实施和测试在市中心初级保健诊所接受非裔美国人、西班牙裔和白人虐待妇女的护士病例管理和团体教育的有效性。这些诊所是全县系统的一部分，该系统维护住院和门诊就诊的计算机化信息系统。这项基于理论的干预将建立在经过经验测试的组成部分之上，这些组成部分旨在：增加安全规划行为；提高安全行为的自我效能；减少虐待的频率和严重程度；改善身体、情感和社会福祉；减少计划外的医疗利用；以及提高工作效率。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18-44岁就医的妇女进行连续抽样，以确定是否存在家庭暴力，直到获得400名受虐待妇女的样本。参与者将按析因设计随机分为4个处理单元：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。护士案例管理将包括安全规划、危机管理、支持性护理、前瞻性指导和转诊方面的教育。团体教育将由当地法律、社会和教育机构为受虐妇女举办的课程组成。析因研究设计将允许检验团体教育和护士病例管理的主要效果，以及团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交互作用。随机化后，将在基线和每隔6个月收集措施，为期3年。将从社会和卫生保健系统的角度，利用四种替代疗法的成本效益分析，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.