Lowering the threshold for discussions of domestic violence: A randomized controlled trial of computer screening

Karin V. Rhodes, Melinda Drum, Elizabeth Anliker, Richard Frankel, David S. Howes, Wendy Levinson

Research output: Contribution to journalArticle

81 Citations (Scopus)

Abstract

Background: Women experiencing domestic violence (DV) frequent health care settings, but DV is rarely identified. Methods: We conducted a randomized controlled trial to determine the effect of computer screening on health care provider-patient DV communication at 2 socioeconomically diverse emergency departments (EDs). Consenting nonemergent female patients, aged 18 to 65 years, were randomized to self-administered computer-based health risk assessment, with a prompt for the health care provider, or to "usual care"; all visits were audiotaped. Outcome measures were rates of DV discussion, disclosure, and services. Results: Of 2169 eligible patients, 1281 (59%) consented; 871 (68%) were successfully audiotaped, and 903 (71%) completed an exit questionnaire. Rates of current DV risk on exit questionnaire were 26% in the urban ED and 21% in the suburban ED. In the urban ED, the computer prompt increased rates of DV discussion (147/262 [56%] vs 123/275 [45%]; P=.004), disclosure (37/262 [14%] vs 23/275 [8%]; P=.07), and services provided (21 [8%] vs 10 [4%]; P=.04). Women at the suburban site and those with private insurance or higher education were much less likely to be asked about experiences with abuse. Only 48% of encounters with a health care provider prompt regarding potential DV risk led to discussions. Both inquiries about and disclosures of abuse were associated with higher patient satisfaction with care. Conclusions: Computer screening for DV increased but did not guarantee that DV would be addressed during ED encounters. Nonetheless, it is likely that low-cost interventions that allow patients the opportunity to self-disclose can be used to improve detection of DV.

Original languageEnglish
Pages (from-to)1107-1114
Number of pages8
JournalArchives of Internal Medicine
Volume166
Issue number10
DOIs
StatePublished - May 22 2006

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Domestic Violence
Randomized Controlled Trials
Hospital Emergency Service
Disclosure
Health Personnel
Insurance
Patient Satisfaction
Communication
Outcome Assessment (Health Care)
Delivery of Health Care
Education
Costs and Cost Analysis

ASJC Scopus subject areas

  • Internal Medicine

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Lowering the threshold for discussions of domestic violence : A randomized controlled trial of computer screening. / Rhodes, Karin V.; Drum, Melinda; Anliker, Elizabeth; Frankel, Richard; Howes, David S.; Levinson, Wendy.

In: Archives of Internal Medicine, Vol. 166, No. 10, 22.05.2006, p. 1107-1114.

Research output: Contribution to journalArticle

Rhodes, Karin V. ; Drum, Melinda ; Anliker, Elizabeth ; Frankel, Richard ; Howes, David S. ; Levinson, Wendy. / Lowering the threshold for discussions of domestic violence : A randomized controlled trial of computer screening. In: Archives of Internal Medicine. 2006 ; Vol. 166, No. 10. pp. 1107-1114.
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abstract = "Background: Women experiencing domestic violence (DV) frequent health care settings, but DV is rarely identified. Methods: We conducted a randomized controlled trial to determine the effect of computer screening on health care provider-patient DV communication at 2 socioeconomically diverse emergency departments (EDs). Consenting nonemergent female patients, aged 18 to 65 years, were randomized to self-administered computer-based health risk assessment, with a prompt for the health care provider, or to {"}usual care{"}; all visits were audiotaped. Outcome measures were rates of DV discussion, disclosure, and services. Results: Of 2169 eligible patients, 1281 (59{\%}) consented; 871 (68{\%}) were successfully audiotaped, and 903 (71{\%}) completed an exit questionnaire. Rates of current DV risk on exit questionnaire were 26{\%} in the urban ED and 21{\%} in the suburban ED. In the urban ED, the computer prompt increased rates of DV discussion (147/262 [56{\%}] vs 123/275 [45{\%}]; P=.004), disclosure (37/262 [14{\%}] vs 23/275 [8{\%}]; P=.07), and services provided (21 [8{\%}] vs 10 [4{\%}]; P=.04). Women at the suburban site and those with private insurance or higher education were much less likely to be asked about experiences with abuse. Only 48{\%} of encounters with a health care provider prompt regarding potential DV risk led to discussions. Both inquiries about and disclosures of abuse were associated with higher patient satisfaction with care. Conclusions: Computer screening for DV increased but did not guarantee that DV would be addressed during ED encounters. Nonetheless, it is likely that low-cost interventions that allow patients the opportunity to self-disclose can be used to improve detection of DV.",
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