Provider Knowledge, Screening Rates, and Institutionalization of an IPV Protocol: Midpoint Findings from the M Health Community Network

Purpose: Approximately 1 in 4 females and 1 in 10 males in the U.S. have experienced physical violence, sexual violence, or stalking by an intimate partner.  Intimate partner violence (IPV) victimization is associated with substantial mental and physical health consequences, high medical care costs, and high rates of health service utilization.  The US Preventive Services Task Force and Institute of Medicine recommend IPV screening for women of childbearing age; yet, only 2%-50% of healthcare providers routinely screen female patients.  In this study, we examined changes in provider knowledge and practice and the degree of institutionalization of the M Health Community Network—a community-university IPV-response project in a large multi-specialty outpatient clinic setting.  The Network uses an organizational intervention approach which encompasses culturally competent care, routinized documentation, and care coordination between clinic providers and community network partners.

Method: Data were taken from surveys, interviews, and electronic health records over a period of 12 months.  A modified version of the Physician Readiness to Manage Intimate Partner Violence Survey was used to measure changes in IPV preparation, knowledge, and opinions among three groups of health care providers (n=30 medical providers, 76 nursing staff, and 25 behavioral health providers).  Constructs from the Consolidated Framework for Implementation Research were integrated into process evaluation interviews (n=8 clinics; managers and rooming staff) to assess the institutionalization of the new evidence-based screen and response protocol, and electronic health records (n=150,000+ patients) were used to capture IPV screening rates across clinics. 

Results: IPV knowledge and opinion scale scores between baseline and midpoint did not significantly change for any of the three provider groups (all p ≥ 0.05).  Routinized screening of all adult patients has been variable across clinics and administrative support has vacillated with leadership turnover.  Staff expressed some challenges with fitting the IPV screen into the rooming process but also shared success stories and positive patient interactions as a result of screening.  Screening rates improved across all clinics and over 500 survivors have been identified and offered support via clinic and community resources.  However, the majority of clinics only screen 30-70% of eligible patients; and, the lacking in-clinic response and the low use of community connections are a concern.

Conclusion: Researchers have reported that interactions with a health care provider who expresses support and concern result in some women recognizing they could obtain safety and a better situation.  Our project was designed to facilitate system-level change for how health care providers screen and respond to patients who experience IPV.  Despite support from individual stakeholders and many accomplishments over one year, widespread changes in clinic practice have been challenged by a lack of buy-in, staff turnover, and competing clinic priorities.