Department of Family and Community Medicine, University of California San Francisco, San Francisco, California.
California ACES Learning and Quality Improvement Collaborative (CALQIC), University of California San Francisco, San Francisco, California.
Am J Prev Med. 2021 Sep;61(3):439-444. doi: 10.1016/j.amepre.2021.02.010. Epub 2021 May 19.
Screening for interpersonal violence is used in healthcare settings to identify patients experiencing violence. However, using unvalidated screening tools may misclassify patients' experience with violence. The Center for Medicare & Medicaid Innovation adapted a previously validated intimate partner violence screening tool for use in assessing interpersonal violence and retained the tool's original scoring rubric, despite the new tool's broader scope. This study evaluates the scoring system for detecting safety concerns.
This was a cross-sectional survey of a convenience sample of adult patients and caregivers of pediatric patients at 7 primary care clinics and 4 emergency departments (2018-2019). Surveys included the adapted 4-item Hurt Insult Threat Scream tool. Questions are scored by frequency on a Likert scale (1=never; 5=frequently). Scores of 11-20 are considered positive for safety concerns. Two-sided Fisher's exact tests were used for descriptive analyses. Data analyses occurred in 2019-2020.
Of 1,014 participants, 66 (6.5%) reported any frequency of physical violence. Of these, 54 (81.8%) did not reach the threshold score of 11. Of the 1,014 participants, 93 (9.2%) reported any frequency of physical violence or being threatened with harm; 76 of 93 participants (81.7%) scored <11.
Using the original scoring criteria for the adapted Hurt Insult Threat Scream, >80% of participants reporting physical violence did not screen positive for potential safety concerns. The scoring criteria did not reliably identify participants experiencing or at high risk for violence. To improve patient safety, the adapted Hurt Insult Threat Scream scoring rubric should be updated on the basis of stakeholder input and additional validation studies.
在医疗保健环境中，筛查人际暴力是用于识别遭受暴力的患者的方法。然而，使用未经验证的筛查工具可能会错误分类患者的暴力经历。医疗保险和医疗补助服务中心（CMS）创新中心对先前验证过的亲密伴侣暴力筛查工具进行了改编，用于评估人际暴力，并保留了该工具的原始评分标准，尽管新工具的范围更广。本研究评估了检测安全问题的评分系统。
这是一项对 7 个初级保健诊所和 4 个急诊部的成年患者及其儿科患者的照顾者进行的横断面调查（2018-2019 年）。调查包括改编后的 4 项伤害、侮辱、威胁和尖叫工具。问题通过李克特量表的频率进行评分（1=从不；5=经常）。得分 11-20 被认为存在安全问题。使用双侧 Fisher 精确检验进行描述性分析。数据分析于 2019-2020 年进行。
在 1014 名参与者中，有 66 名（6.5%）报告了任何频率的身体暴力。其中，54 名（81.8%）未达到 11 分的阈值得分。在 1014 名参与者中，有 93 名（9.2%）报告了任何频率的身体暴力或受到伤害威胁；93 名参与者中有 76 名（81.7%）得分<11。
使用改编后的 Hurt Insult Threat Scream 的原始评分标准，>80%报告身体暴力的参与者未筛查出潜在的安全问题。该评分标准未能可靠地识别出经历或高风险暴力的参与者。为了提高患者安全，应根据利益相关者的意见和额外的验证研究，更新改编后的 Hurt Insult Threat Scream 评分标准。
