Women's Health Sciences Division, National Center for PTSD, VA Boston Healthcare System, Boston, Massachusetts; Department of Psychiatry, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts.
Center for Healthcare Organization and Implementation Research (CHOIR), VA Boston Healthcare System, Boston, Massachusetts.
Womens Health Issues. 2024 Nov-Dec;34(6):617-627. doi: 10.1016/j.whi.2024.07.001. Epub 2024 Aug 22.
The Veterans Health Administration (VHA) employed implementation facilitation (IF) as a strategy to boost uptake of intimate partner violence (IPV) screening programs in primary care. This study examined the sustainment of screening uptake 1 year after IF and identified factors impacting sustainment success.
A mixed-methods evaluation using quantitative and qualitative data was conducted. IPV screening rates from the conclusion of the IF period (i.e., initial adoption) through the 1-year sustainment period served as the primary outcome. We categorized sites into four groups of screening adoption and sustainment success (high adoption and high sustainment, moderate adoption and moderate sustainment, low adoption and low sustainment, and no adoption and/or no sustainment). Qualitative analysis of key informant interviews was used to identify contextual factors affecting screening 12 months post-IF. A mixed sustainment analysis matrix integrated quantitative and qualitative findings and enabled the identification of cross-site patterns.
Seven of the nine sites sustained IPV screening at the most basic level (saw static or increased screening rates). High adopting and high sustaining sites (n = 3) were marked by consistently supportive medical center leadership, ongoing training for clinicians, clear protocols for responding to positive screens, and robust referral options for women experiencing IPV. Nonsustaining sites (n = 2) were marked by a host of barriers including staffing shortages, competing priorities, and inconsistent messaging from leadership regarding the importance of IPV screening.
Knowing barriers and facilitators to successful IPV screening sustainment can inform health care systems to tailor IF and other implementation strategies to sustain IPV screening in primary care. Sustainment of IPV screening requires attention to a combination of facilitators (e.g., consistent leadership support and robust referral options) as well as addressing key barriers (e.g., staff turnover and competing priorities).
退伍军人健康管理局（VHA）采用实施促进（IF）策略来提高初级保健中亲密伴侣暴力（IPV）筛查计划的采用率。本研究考察了 IF 后 1 年筛查采用的维持情况，并确定了影响维持成功的因素。
采用定量和定性数据的混合方法评估。IF 期间结束时（即初始采用）到 1 年维持期间的 IPV 筛查率作为主要结果。我们将站点分为筛查采用和维持成功的四个组（高采用和高维持、中采用和中维持、低采用和低维持以及无采用和/或无维持）。对关键知情人访谈的定性分析用于确定影响 IF 后 12 个月筛查的背景因素。综合使用定量和定性发现的混合维持分析矩阵能够识别跨站点模式。
九个站点中有七个维持了最基本的 IPV 筛查水平（看到静态或增加的筛查率）。高采用和高维持的站点（n=3）的特点是医疗中心领导层始终如一的支持、临床医生的持续培训、对阳性筛查的明确反应方案以及为遭受 IPV 的女性提供强有力的转介选择。非维持站点（n=2）的特点是存在一系列障碍，包括人员配备短缺、优先事项竞争以及领导层对 IPV 筛查重要性的信息不一致。
了解成功的 IPV 筛查维持的障碍和促进因素可以为医疗保健系统提供信息，以便针对特定情况调整 IF 和其他实施策略，以维持初级保健中的 IPV 筛查。维持 IPV 筛查需要关注一系列促进因素（例如，始终如一的领导层支持和强有力的转介选择）以及解决关键障碍（例如，人员流动和优先事项竞争）。
