Use of EHR-Embedded Tools to Improve Screening for Intimate Partner Violence

Screening for intimate partner violence is difficult, often not done

One in four people experience intimate partner violence (IPV) at least once. Unfortunately, there are barriers to connecting those who have experienced such violence with the resources they need to be safe. While screening for IPV at primary care visits is a United States Preventive Services Task Force–recommended service, regular screening for IPV occurs much less frequently than screening for other health concerns, such as depression. Additionally, some traditional methods for IPV screening fail to provide patients with the privacy needed to feel comfortable discussing the issue.

While clinicians agree that IPV is a significant health threat and that screening is critical, there is a lack of guidance about what screenings should look like, according to Dr. Alyssa Rheingold, a clinical psychologist at the Medical University of South Carolina. This lack of clarity can create an additional barrier for clinicians to screen effectively for IPV. “This is an uncomfortable and sensitive subject—one that can make it hard to get through a scheduled patient visit in the 15 minutes allotted,” she said.

A suite of tools to increase screening and referral for IPV

Researcher Dr. Leslie Lenert, who directs the Biomedical Informatics Center at the Medical University of South Carolina, worked with Dr. Rheingold on this problem. They developed and evaluated an integrated suite of electronic health record (EHR) tools that automates best practices for IPV screening and intervention during primary care visits. These tools provide a more automated, private, and effective screening and referral process.

The first intervention is an alert that appears in a patient’s EHR annually to remind healthcare providers to screen for IPV. The researchers made the alert noninterrupting, meaning it would not prevent clinicians from taking other actions on the screen. This ensures the alert will not need to be dismissed without reading it. For the second intervention, patients were given access to a computer to fill out an IPV questionnaire in private without other family members present. Finally, if a patient’s answers indicate the possibility of IPV, the system then prompts providers to use a decision-making tool to guide a followup conversation, supports documentation of an IPV-specific physical examination, and provides referrals to counseling and other services.

Increased opportunities for IPV conversations

Researchers tested the interventions against more traditional IPV screening methods in 15 clinics with nearly 20,000 female patients and found the interventions improved IPV screening. The rate of screenings increased from 45.2 percent to 65.3 percent of patients when the alert was active. In addition, the confidential self-screening process boosted the number of patients identified at risk of IPV, with 130 patients identified as at risk in the intervention group versus just 9 patients flagged in the control group.

Although the interventions improved the screening process, researchers found that most patients identified as at risk of IPV declined referrals for services. Dr. Rheingold notes, “We need to appreciate that it’s a very complex and dynamic situation, but the important thing is starting those conversations, and creating those relationships.”

“A three-part EHR-based intervention is highly effective in both increasing the frequency of screening and the number of patients identified as at risk for significant future physical IPV related injuries.” – Dr. Leslie Lenert

The research team suggests further work to optimize the complex process of adding counseling for IPV risk prevention in people detected to be at risk to better support patients who decline outside services.