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The 130th Annual Meeting of APHA |
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The 130th Annual Meeting of APHA |
Paul Meissner, MSPH, Department of Family Medicine and Community Health, Montefiore Medical Center, 3544 Jerome Avenue, Bronx, NY 10467 and Mary J. Zachary, MD, MS, Department of Family Medicine and Community Health, Albert Einstein College of Medicine, 1300 Morris Park Avenue, Belfer 906, Bronx, NY 10464, 718-430-2752, pmeissne@montefiore.org.
The U.S. medical community has endorsed routine screening for domestic violence for the last decade. In 1999, the Human Services and Resources Administration Maternal Child Health Bureau funded four programs to address domestic violence screening during pregnancy. Our project illustrates important policy implications across three levels: local service delivery, state and health plan quality improvement monitoring, and local, state and federal service financing.
On the local service delivery level, support for onsite, or readily accessible domestic violence services is urgently needed. This must be coupled with ongoing attention to provider education and outreach activities to patients. We have estimated that one domestic violence advocate is needed for every 1,000 women receiving primary care services, translating into 100-200 referrals for domestic violence intervention annually.
State and managed care plan quality improvement efforts are needed to reinforce preventive care efforts. Programs such as HEDIS (national) and QUARR (state) are examples of monitoring activities by state health agencies and health plans that could hold providers accountable for domestic violence screening.
Administrative and financial constraints are also important barriers. Changes in reimbursement strategies from federal, state, and local organizations must recognize the complexity of interventions required for domestic violence interventions, and the need for provider incentives. At this time, medical providers are not reimbursed for patient care related to domestic violence.
Reimbursement inadequacies, local support for domestic violence services, and a lack of systematic quality improvement efforts pose significant barriers to improving the care of women experiencing domestic violence.
Learning Objectives:
Keywords: Domestic Violence, Pregnancy
Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.