| Performance Category | Example of Measure | Scoring (points) | |
|---|---|---|---|
| 1. Hospital policies and procedures | Are there official, written hospital policies regarding the assessment and treatment of victims of domestic violence? | No (0) | Yes (1) |
| 2. Hospital physical environment | Are there posters and/or brochures related to domestic violence on public display in the hospital? If yes, list total number of locations (up to 35). | No (0) | Yes (1-35) |
| 3. Hospital cultural environment | In the last 3 years, has there been a formal (written) assessment of the hospital staff's knowledge and attitude about domestic violence? If yes, which groups have been assessed? a) nursing staff... |
No (0) | Yes (7) |
| 4. Training of providers | Has a formal training plan been developed for the institution? | No (0) | Yes (10) |
| 5. Screening and safety assessment | Is a standardized safety assessment performed and discussed with victims who screen positive for domestic violence? | No (0) | Yes (27) |
| 6. Documentation | Does the hospital use a standardized documentation instrument to record known or suspected cases of domestic violence? If yes, does the form include: a) information on the results of domestic violence screening? ... |
No (0) | Yes (10) |
| 7. Intervention services | Is there a standard intervention checklist for staff to use/refer to when victims are identified? | No (0) | Yes (14) |
| 8. Evaluation activities | Is there any measurement of client satisfaction and/or community satisfaction with the domestic violence program? | No (0) | Yes (19) |
| 9. Collaboration | Does the hospital collaborate with local domestic violence programs? If yes, which types of collaboration apply: a) collaboration with training? ... |
No (0) | Yes (10) |
Source: Agency for Healthcare Research and Quality. Delphi Instrument for Hospital-based Domestic Violence Programs. AHRQ Web site: www.ahrq.gov/research/domesticviol/dvtool.htm. Accessed Oct 16, 2002.