The 131st Annual Meeting (November 15-19, 2003) of APHA

Abstract #61132

Mary M. Duncan, PhD, Community Medicine and Health Care, UConn Health Center, 263 Farmington Avenue, MC 6325, Farmington, CT 06030-6325, (860) 679-1518, mduncan@nso1.uchc.edu, Patricia A. McIntosh, MSW, MPH, Domestic Violence Prevention, Hartford Hospital, 80 Seymour Street, MC 5037, Hartford, CT 06106, Catherine D. Stayton, MPH, DrPH, Health and Nutrition Sciences, Brooklyn College, 2900 Bedford Avenue, Brooklyn, NY 11210, and Charles B. Hall, PhD, Epidemiology and Social Medicine, Einstein College of Medicine, 1300 Morris Park Avenue, Bronx, NY 10461.

The aim of this project was to improve domestic violence screening during prenatal care. We trained clinicians to screen at first medical visit, week 16 and week 28 of pregnancy. We gave four individualized performance feedback reports to Advanced Practice Nurses and Obstetrics and Gynecology residents caring for low income pregnant women in a hospital-based clinic in a northeastern city. We evaluated the effectiveness of feedback by comparing pre-intervention and intervention screening rates. Team A and B APRNs and Team A residents screened well from the start (over 90% of protocol visits) and did not improve significantly. Team B and C residents improved from 39.5% of required visits before feedback to 94.1% after the fourth report (Chi Square 39.39, p < .001). Team C APRNs improved from 23.5% before feedback to 52.6% after the fourth report (Chi Square 19.6, p = .001). Among residents, the probability of screening increased approximately 48% with each feedback report, adjusting for patient care team (OR: 1.4796; 95% CI: 1.2743, 1.7182; p = .001). The finding for APRNs was not statistically significant (OR: 1.167, 95% CI: 0.9438, 1.4432). We used Generalized Estimating Equations to adjust for the lack of independence across repeated patient visits. Future analyses will assess screening at six and nine months post-intervention, will include additional baseline data, and will include patient and provider characteristics that may influence screening. In addition, we will examine changes in documentation and change in the number of abuse cases identified.

Learning Objectives:

At the conclusion of the session, participants will be able to
• Judge the effectiveness of individualized performance feedback as a tool for improving domestic violence screening during prenatal care.
• Begin designing a practical feedback program for their clinical settings.

Keywords: Domestic Violence, Screening

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.