Electronic health record-based programs can increase screening for intimate partner violence

1. In a cluster randomized clinical trial, electronic health record (EHR)-based intervention increased the frequency of screening and identifying individuals at risk for IPV. 

2. While the intervention was well accepted, improvements are needed to increase detection, as levels still fall below literature values.

Evidence Rating Level: 1 (Excellent) 

Study Rundown:  In the United States intimate partner violence (IPV) poses a significant problem to public health specifically reported among women. The US Preventative Service Task Force recommended screening for IPV; however, it is far less screened for than other health conditions. The experimental group was compared to oral screening for IPV done by nurses, which was used as the baseline and control group. The primary outcome, the IPV screening rate for the patients, was the proportion of patients among those eligible who completed the IPV questions. Along with this, another primary outcome was the IPV detection rate by screening procedures. The IPV workflow consists of a noninterruptive alert for annual screening, partner violence screening (PVS) confidential report, danger assessment-5 (DA-5) used to measure risk severity, and confidential results. Patients with certain demographic characteristics (older age, single, public insurance, and from racial and ethnic minority groups) were likely to be screened less often which is particularly concerning as they are also likely to screen positive for IPV risk, thus limiting the study. Overall, the confidential screening process intervention was effective at increasing the screening adherence and the detection rate of IPV in family medicine clinics, shaping future IPV approaches to obtain high detection rates while maintaining the privacy and safety of the patients. 

Click here to read the study in JAMA Network Open 

In-Depth [Randomized Clinical Trial]: This randomized trial was conducted throughout 15 family medicine primary care clinic in South Carolina, and included a total of 17 433 patients (mean [SD] age, 34.1 [8.6] years; 2542 [14.6%] with Medicaid or Medicare coverage and 14 891 [85.4%] with private, military, or other insurance) in the nurse-led screening, and 8895 (mean [SD] age, 34.6 [8.7] years; 1270 [14.3%] with Medicaid or Medicare coverage and 7625 [85.7%] with private, military, or other insurance) patients in the PVS and nurse-led screening. Through 34 157 visits, the PVS questionnaire was completed in 9707 visits when the high-privacy screening was assigned (28.4%). Noninterruptive screening alerts increased the rate of screening from 45.2% (10 268 of 22 730 visits) to 65.3% (22 303 of 34 157 visits) (RR vs without the noninterruptive alert, 1.46 [95% CI, 1.44-1.49]; P<.001). When compared to the nurse-les screening, the high privacy screening was more effective at identifying patients with potential IPV risks. The nurse-led screening only identified 9 of 17 433 patients (0.1% [95% CI, 0.02%-0.1%]) as at risk for IPV, whereas a total of 130 of 8895 patients (1.5% [95% CI, 1.2%-1.7%]) reported experiencing IPV in the past year according to the PVS questionnaire. There was a decline in likelihood of screening completion not in the first visit (RR, 0.89 [95% CI, 0.88-0.90]; P < .001). Non-white, unmarried older and those under Medicare or Medicaid were less likely to complete the screening as well. The use of a noninterruptive alert for annual IPV screening increased the use of screening, confidential screening through self-reporting identified more patients with a potential IPV risk, confidential PVS screening found true cases at risk for IPV, all proving the effectiveness of the intervention. 

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