19985 VA Connecticut Healthcare System, West Haven, CT, USA.
Yale School of Medicine, New Haven, CT, USA.
Public Health Rep. 2021 Jan/Feb;136(1):52-60. doi: 10.1177/0033354920966022. Epub 2020 Nov 18.
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.
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.
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 ( = .02). Emergent themes reflected barriers and facilitators for IPV screening implementation.
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.
退伍军人健康管理局设立了综合性妇女健康诊所（CWHC），为女性退伍军人提供协调、高质量的初级保健。亲密伴侣暴力（IPV）在使用这些诊所的女性中很普遍。退伍军人健康管理局建议对 IPV 进行筛查，但全国范围内 CWHC 的筛查率很低。我们描述了一项多站点质量改进倡议，以加强退伍军人健康管理局 CWHC 中 IPV 筛查实践的采用。
这项质量改进倡议于 2017-2018 年实施，包括 4 个步骤，我们（1）对全美 CWHC 的筛查实践进行了基线调查；（2）根据确定的障碍和促进因素选择和调整基于证据的实施策略；（3）针对低采用设施部署多组分实施支持；（4）使用定量和定性分析，从基线（2017 年冬季）到 1 年随访（2018 年冬季）进行后续调查，评估 IPV 筛查实践的变化。
来自 62 个 CWHC 站点的响应者提供了有关 IPV 筛查实践和障碍的信息；42 个低采用站点被确定为实施支持的目标。在随访时，响应者提供了有关 IPV 筛查实践、实施支持策略的有用性以及持续存在的障碍的信息。在对两次调查都做出回应的站点（n=47）中，实施推荐筛查实践的站点数量从基线的 15 个增加到随访时的 25 个，增加了 66.7%（=.02）。出现的主题反映了 IPV 筛查实施的障碍和促进因素。
CWHC 中 IPV 筛查实践的改善是加强妇女护理的关键步骤。然而，即使有许多实施支持，许多站点仍然存在采用障碍。关于可改变障碍和独特促进因素的发现可以为提高筛查率提供下一步的指导。
