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The 130th Annual Meeting of APHA |
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The 130th Annual Meeting of APHA |
Judith N. Sabino, MPH1, Suzanne L. Smith, MBA1, Julie Dostal, MD2, Pamela J. Pillsbury, MED3, Mark J. Young, MD4, Lawrence C. Kleinman, MD, MPH5, Eric J. Gertner, MD MPH6, and Charles Worrilow, MD7. (1) Department of Community Health and Health Studies, Lehigh Valley Hospital, 17th and Chew Streets, PO Box 7017, Allentown, PA 18105-7017, 610-402-2444, judith.sabino@lvh.com, (2) Department of Family Practice, Lehigh Valley Hospital, 17th and Chew Streets, P.O. Box 7017, Allentown, PA 18105-7017, (3) Community Education, Turning Point of Lehigh Valley, Inc., P.O. Box 1705, Allentown, PA 18105, (4) Department of Community and Health Studies, Lehigh Valley Hospital, Penn State University College of Medicine, 227 North 17th Street, Allentown, PA 18104, (5) Health Studies Unit, Lehigh Valley Hospital and Health Network, 17th & Chew Streets, Allentown, PA 18105, (6) Division of General Internal Medicine, Lehigh Valley Hospital, Allentown (PA), 1210 South Cedar Crest Blvd, Suite 3600, Allentown, PA 18103, (7) Lehigh Valley Hospital, Department of Emergency Medicine, P.O. Box 689, Allentown, PA 18105
Background: Domestic violence (DV) is an important public health problem that is prevalent among broad populations of women. Effective and routine screening and provision of resource information at each health care visit with subsequent advice and referral for those screened positive are recommended. Sensitivity of screening increases with repetition of asking the question. DV screening is considered a form of assessment and an intervention.
Objectives: To evaluate changes in the rates of documented DV screening, advice and referral in the medical records of patients seen in the emergency department (ED) internal medicine (IM), and family practice (FP) outpatient teaching practices at Lehigh Valley Hospital, a premier academic community hospital in Allentown, Pennsylvania, resulting from a brief educational interventions and simple modification of charting forms.
Methods: Randomly chosen charts of women aged 15- 65 were reviewed before and after interventions. Attending and resident physicians staffed the ED, FP and IM practices. Screening and rates of advice and referral for positive screens were measured before and after the interventions. The educational intervention consisted of didactic sessions and small group discussions lasting from 30 to 120 minutes. Chart modification included addition of a place to document screening on a patient history intake form.
Results: There was no evidence of screening or advice and referral in the ED (150 charts) or IM (119) at baseline. ED screening rose to 44% (66/150) after intervention (IM data pending). Baseline and follow up rates for screening were similar (39% of 93 charts and 34% of 111 charts) before and after interventions at the family practice site. No positive screens were identified in ED. At the FP the rates of positive screens was 22% pre- intervention and 32% post-intervention. Advice and referral rates as documented in the chart increased from 25% to 42%.
Conclusions: The study interventions increased screening rates in the ED and the advice and referral rates in FP. The differences in positive screens obtained in the ED vs FP suggests there are more issues surrounding a patient's choice to disclose DV issues other than just being asked. The DV literature suggests that asking the question and providing resource information is clinically important even if women do not report DV. Ongoing efforts are underway to study and modify the culture, environment, processes of care and documentation in the ED, FP, and IM to support more effective screening of women who are victims of domestic violence.
Learning Objectives:
Keywords: Domestic Violence, Women's Health
Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.