Electronic Health Record-Based Screening for Intimate Partner Violence: A Cluster Randomized Clinical Trial.

Area of Science:

• Public Health
• Clinical Informatics
• Women's Health

Background:

• Intimate partner violence (IPV) affects 25% of women, posing a significant public health challenge.
• Primary care screening for IPV is recommended, but its effectiveness remains debated.
• Current screening methods may have limitations in detection rates and patient privacy.

Purpose of the Study:

• To evaluate the impact of an electronic health record (EHR)-integrated multifactorial intervention on IPV risk detection in primary care.
• To assess the effectiveness of a novel screening approach in a real-world clinical setting.

Main Methods:

• A cluster randomized clinical trial with a stepped-wedge design was conducted across 15 primary care clinics.
• The intervention involved non-interruptive EHR alerts, confidential computer-based questionnaires, and decision support tools.
• Eligible participants included women aged 18-49 years receiving care at participating clinics.

Main Results:

• The EHR-based intervention significantly increased IPV screening rates from 45.2% to 65.3% (RR, 1.46; P < .001).
• Confidential screening via computer questionnaire identified 1.5% of patients reporting past-year IPV, compared to 0.1% with baseline oral screening.
• The intervention demonstrated a higher positive detection rate for IPV risk.

Conclusions:

• The EHR-based multifactorial intervention proved effective in enhancing screening adherence and detection rates for IPV in primary care.
• A highly private screening approach is crucial for improving IPV detection and addressing patient safety concerns.
• This study highlights the potential of technology-driven interventions in addressing sensitive health issues within primary care settings.