From Warm Handoff to Wrap Around Care: A Multiple Baseline Study of IPV in Emergency Departments

Background

Up to 14% of women treated in the ED are there due to violence from an intimate partner, which accounts for at least 1.4 million ED visits annually. When victims are able to make contact with a victim advocacy agency, repeat IPV victimization decreases. An effective way of doing so is a direct connection between providers, or “warm hand-off,” yet, these are rare, and rates of screening and subsequent supportive services are low.

A novel digital intervention, Domestic Violence Report and Referral, facilitates such a direct connection between referring ED providers and domestic violence advocacy. The present study analyzes the impact of DVRR on patient receipt of supportive services through answering whether this intervention affects the rate of advocacy referrals given to, and services received by, IPV-identified patients in the ED.

Methods

These research questions were addressed using a multiple-baseline design. DVRR was implemented at two (staggered) time points across three urban hospitals in Northern California. Patient medical records documented at three participating EDs during the 5-year study period were reviewed if the specified visit was for a patient 18 years or older and included a positive screen for DV. Of 5618 medical records reviewed, 2265 were confirmed to be DV-related by specific diagnosis or mention in chart notes. 634 of these preceded DVRR implementation, and 1450 followed DVRR implementation at their hospital. In total, 876 patients received the DVRR intervention. Blinded research assistants conducted chart reviews and were monitored for interrater reliability greater than 0.9 throughout.

A subsequent chart review was performed at a participating advocacy agency. A list of patients with confirmed IPV at each hospital was sent to the participating advocacy agency to confirm or deny whether supportive services had been offered to each client.

Analytical approaches will consist of interrupted time series analysis, as well as the descriptive (chi square and visual) analyses typical of a multiple baseline design.

Results

Current data (collection is ongoing, expected to complete in summer 2019) indicates that the rate of advocacy referrals given to IPV-identified patients in the ED changed from 63% of patients before the implementation of DVRR to 80% of patients afterwards, representing a 1.27-fold increase that is significant at the p<<0.01 level.

In addition, the rate of advocacy services received by IPV-identified patients at that hospital changed from 9% of patients before implementation of DVRR to 37% of patients afterwards, representing a 4-fold increase that is significant at the p<<0.01 level.

Further analyses will include deeper time-series analysis, as well as detailed breakdowns by patient demographics such as race and ethnicity.

Discussion and Conclusion

The implementation of DVRR and related interventions may dramatically expand access to supportive services for DV survivors who have visited the ED. Future research may examine the effect of DVRR on hospital care, including return patient visits to the ED. This is a critical and welcome intervention for this highly vulnerable population.