Addressing Intimate Partner Violence Among Women Veterans: Evaluating the Impact and Effectiveness of VHA's Response.

背景：亲密伴侣暴力（IPV）在女性退伍军人（WVs）中很常见，近20%的 在退伍军人健康管理局（VHA）初级保健诊所接受治疗的WVs经历了去年的IPV。VHA的 妇女保健服务、IPV援助方案以及初级保健和心理保健办公室 健康和自杀预防制定了实施IPV筛查计划的建议， 初级保健.超过三分之二的WV初级保健患者接受“模式1”的护理（即，混合性别 初级保健）和“模式2”（即，单独但共享空间）诊所，但这些诊所的筛查率很低， 诊所。因此，WHS计划使用混合促进（BF）在模型1中推出IPV筛查计划， 2型初级保健诊所。鉴于整个VHA中这些诊所的数量很多，目前尚不清楚是否 资源密集型BF是可行的并且是否采用不太密集的策略（即，工具包+作为工具的实施 [2019 - 04 - 25]有效。还需要对IPV筛查计划的临床有效性进行研究。 意义/影响：鉴于IPV在WV中的高流行率及其显著的健康影响， IPV筛查计划的成功实施有望改善医疗保健服务， 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 全球IPV筛查项目的临床有效性。它是创新的，包括四个强大的VHA 致力于成功实施IPV筛查计划的运营合作伙伴。这个项目 利用一个时间敏感的机会，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价两项战略， IPV筛选方案通过实现三个具体目标。(1)评估覆盖率、采用率， 实施保真度，并使用两种IPV筛选实施策略实现维护 程序. (2)评估IPV筛查计划的临床有效性，以披露率为证据 以及筛查后心理社会服务的使用情况。(3)识别IPV筛查的多层次障碍和促进因素 方案实施和维持。 方法：我们提出了一个集群随机化，阶梯楔形，混合II型程序评估设计， 比较两种实施策略（BF +工具包vs.工具包+ IAU）和临床 IPV筛查计划的有效性。我们提出了一种混合方法的方法来收集定量的 （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）， 以及定量（临床记录数据）临床有效性结局（目标2）。我们将补充这些 数据收集方法和评估执行战略的调查， BF后和维护阶段。2002年科研实施综合推进行动 卫生服务（i-PARIHS）框架将指导定性数据的收集和分析。总结性数据 将使用覆盖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， 未来的实施战略和临床实践，以传播IPV筛查计划，以所有VHA主要 保健诊所和其他临床环境，使这一重要的干预措施是所有西弗吉尼亚州VHA患者。

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.