A Multisite Quality Improvement Initiative to Enhance the Adoption of Screening Practices for Intimate Partner Violence Into Routine Primary Care for Women Veterans

• Published in: Public health reports (1974) 2021-01, Vol.136 (1), p.52-60
• Main Authors: Portnoy, Galina A., Iverson, Katherine M., Haskell, Sally G., Czarnogorski, Maggie, Gerber, Megan R.
• Format: Article
• Language: English
• Subjects: Adoption; Aggression; Barriers; Clinics; Diagnostic Screening Programs - organization & administration; Domestic violence; Female; Health care; Health services; Hospital administration; Humans; Implementation; Intimate partner violence; Intimate Partner Violence - prevention & control; Management; Medical diagnosis; Polls & surveys; Primary care; Primary Health Care; Program Evaluation; Public Health Evaluation; Qualitative analysis; Qualitative research; Quality control; Quality Improvement; Quality of care; Screening; Tests; United States; United States Department of Veterans Affairs; Veterans; Veterans Health Services; Violence; Winter; Women; Women's Health; Womens health
• ISSN: 0033-3549; 1468-2877
• DOI: 10.1177/0033354920966022

Objective The Veterans Health Administration established comprehensive women’s health clinics (CWHCs) to provide coordinated, high-quality primary care to women veterans. Intimate partner violence (IPV) is prevalent among women using these clinics. The Veterans Health Administration recommends screening women for IPV, yet screening uptake is low in CWHCs nationwide. We describe a multisite quality improvement initiative to enhance the adoption of IPV screening practices in the Veterans Health Administration’s CWHCs. Methods This quality improvement initiative, implemented in 2017-2018, included 4 steps in which we (1) conducted a baseline survey of screening practices at CWHCs throughout the United States; (2) selected and tailored evidence-based implementation strategies based on identified barriers and facilitators; (3) deployed multicomponent implementation support, targeting low-adopting facilities; and (4) conducted a follow-up survey to evaluate changes in IPV screening practices from baseline (winter 2017) to 1-year follow-up (winter 2018) using quantitative and qualitative analyses. Results Responders from 62 CWHC sites provided information on IPV screening practices and barriers; 42 low-adopting sites were targeted for implementation support. At follow-up, responders provided information on IPV screening practices, perceived usefulness of implementation support strategies, and continued barriers. Among sites that responded to both surveys (n = 47), the number of sites that implemented recommended screening practices increased by 66.7%, from 15 at baseline to 25 at follow-up (P = .02). Emergent themes reflected barriers and facilitators for IPV screening implementation. Conclusions Improvement in IPV screening practices in CWHCs is a pivotal step toward enhancing care for women. Yet, even with numerous implementation supports, barriers to adoption persist at many sites. Findings on modifiable barriers and unique facilitators can inform next steps for increasing screening uptake.