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Complete Summary


TITLE

Domestic violence: percentage of health care staff trained in initial assessment of problems of domestic violence every twelve months.

SOURCE(S)

  • Institute for Clinical Systems Improvement (ICSI). Domestic violence. Bloomington (MN): Institute for Clinical Systems Improvement (ICSI); 2006 Sep. 46 p. [87 references]

Measure Domain

PRIMARY MEASURE DOMAIN

SECONDARY MEASURE DOMAIN

Process

Brief Abstract

DESCRIPTION

This measure assesses the percentage of health care staff trained in initial assessment of problems of domestic violence every twelve months.

RATIONALE

The priority aim addressed by this measure is to increase training opportunities for health care staff for screening and assessment of domestic violence.

PRIMARY CLINICAL COMPONENT

Domestic violence; health care staff training

DENOMINATOR DESCRIPTION

Number of health care staff in primary/urgent care settings identified by medical group as eligible for training (see the "Denominator Inclusions/Exclusions" field in the Complete Summary)

NUMERATOR DESCRIPTION

Evidence Supporting the Measure

EVIDENCE SUPPORTING THE CRITERION OF QUALITY

  • A clinical practice guideline or other peer-reviewed synthesis of the clinical evidence

NATIONAL GUIDELINE CLEARINGHOUSE LINK

Evidence Supporting Need for the Measure

NEED FOR THE MEASURE

Unspecified

State of Use of the Measure

STATE OF USE

Current routine use

CURRENT USE

Internal quality improvement

Application of Measure in its Current Use

CARE SETTING

Ambulatory Care
Behavioral Health Care
Emergency Medical Services
Hospitals
Physician Group Practices/Clinics

PROFESSIONALS RESPONSIBLE FOR HEALTH CARE

Advanced Practice Nurses
Emergency Medical Technicians/Paramedics
Nurses
Physician Assistants
Physicians
Psychologists/Non-physician Behavioral Health Clinicians
Social Workers

LOWEST LEVEL OF HEALTH CARE DELIVERY ADDRESSED

Group Clinical Practices

TARGET POPULATION AGE

Does not apply to this measure

TARGET POPULATION GENDER

Does not apply to this measure

STRATIFICATION BY VULNERABLE POPULATIONS

Does not apply to this measure

Characteristics of the Primary Clinical Component

INCIDENCE/PREVALENCE

Intimate partner violence is common, affecting 25% of women and 11% of men at some time during their lives.

Studies show that 11% to 22% of the women seen in primary care offices are currently experiencing physical abuse. The same is true of 12% to 35% of emergency room visits for women, and 7% to 20% of pregnant women.

According to the National Violence Against Women Survey and review done by the U.S. Department of Justice, there is wide variability in the reported incidence of intimate partner violence in today's literature.

Initial clinical trials have found prevalence from 10 to 30% where concerted efforts have implemented direct respectful routine screenings.

Battered women remain underdiagnosed by the medical community generally, and by primary care physicians specifically. As few as 1 in 20 battered women are correctly diagnosed by the physicians to whom they turn for help.

Recent reports on domestic violence during pregnancy have documented that 7% to 20% of abused women experienced abuse during pregnancy, including White, African American, and Hispanic women and both adult and teen mothers.

Bullock and McFarlane reported 26% of pregnant teens had experienced physical abuse, and about 65% of the abused, pregnant teens had not told anyone about the abuse.

EVIDENCE FOR INCIDENCE/PREVALENCE

ASSOCIATION WITH VULNERABLE POPULATIONS

See "Incidence/Prevalence" and "Burden of Illness" fields.

BURDEN OF ILLNESS

Studies at Kaiser show that self-report exposure to events such as domestic violence during childhood are associated with unintended pregnancy, sexually transmitted diseases, alcohol abuse, smoking, suicide, depression, and risk factors for heart disease, chronic lung disease, and liver disease in adulthood.

Campbell found abuse during pregnancy to be associated with increased severity and frequency of abuse as well as increased risk of homicide.

Abused women are at an increased risk of delivering a low birth weight infant, even after controlling for other risk factors correlated with low birth weight. Prenatal abuse is also correlated with late prenatal care. Domestic abuse can affect the new parent's ability to provide care.

Psychological trauma resulting from chronic abuse produces symptoms which include overwhelming anxiety (including panic attacks, numbness, and tingling), intense fear, confusion, and depression.

EVIDENCE FOR BURDEN OF ILLNESS

UTILIZATION

Unspecified

COSTS

The estimated total cost of intimate partner violence (IPV) (including IPV rape, physical assault, and stalking) against adult U.S. women is $5.8 billion (1995 dollars). Nearly $4.1 billion is for direct medical and mental health care. The remaining $0.9 billion is lost productivity from paid work and household chores for victims of nonfatal IPV. For IPV homicide, $0.9 billion is lost in lifetime earnings.

The annual medical care costs for domestic violence victims at HealthPartners are almost 50% (48.8%) more than age-matched women who are not abused.

EVIDENCE FOR COSTS

  • Institute for Clinical Systems Improvement (ICSI). Domestic violence. Bloomington (MN): Institute for Clinical Systems Improvement (ICSI); 2006 Sep. 46 p. [87 references]

Institute of Medicine National Healthcare Quality Report Categories

IOM CARE NEED

Not within an IOM Care Need

IOM DOMAIN

Not within an IOM Domain

Data Collection for the Measure

CASE FINDING

Does not apply to this measure

DENOMINATOR SAMPLING FRAME

Does not apply to this measure

DENOMINATOR INCLUSIONS/EXCLUSIONS

Inclusions
Number of health care staff* in primary/urgent care settings identified by medical group as eligible for training

*Health care staff (including physicians, nurses, mental health providers, physician assistants, nurse practitioners, midwives, and social workers) in primary care, obstetrics-gynecology, urgent care, and mental health.

Exclusions
Unspecified

RELATIONSHIP OF DENOMINATOR TO NUMERATOR

Does not apply to this measure

DENOMINATOR (INDEX) EVENT

Does not apply to this measure

DENOMINATOR TIME WINDOW

Does not apply to this measure

NUMERATOR INCLUSIONS/EXCLUSIONS

MEASURE RESULTS UNDER CONTROL OF HEALTH CARE PROFESSIONALS, ORGANIZATIONS AND/OR POLICYMAKERS

The measure results are somewhat or substantially under the control of the health care professionals, organizations and/or policymakers to whom the measure applies.

NUMERATOR TIME WINDOW

Fixed time period

DATA SOURCE

Clinician survey
Provider data

LEVEL OF DETERMINATION OF QUALITY

Does not apply to this measure

PRE-EXISTING INSTRUMENT USED

Unspecified

Computation of the Measure

SCORING

Rate

INTERPRETATION OF SCORE

Better quality is associated with a higher score

ALLOWANCE FOR PATIENT FACTORS

Does not apply to this measure

STANDARD OF COMPARISON

Internal time comparison

Evaluation of Measure Properties

EXTENT OF MEASURE TESTING

Unspecified

Identifying Information

ORIGINAL TITLE

Percentage of health care staff trained in initial assessment of problems of domestic violence every twelve months.

MEASURE COLLECTION

DEVELOPER

Institute for Clinical Systems Improvement

FUNDING SOURCE(S)

The following Minnesota health plans provide direct financial support: Blue Cross and Blue Shield of Minnesota, HealthPartners, Medica, Metropolitan Health Plan, PreferredOne, and UCare Minnesota. In-kind support is provided by the Institute for Clinical Systems Improvement's (ICSI) members.

COMPOSITION OF THE GROUP THAT DEVELOPED THE MEASURE

Work Group Members: James Lee, MD, MPH (Work Group Leader) (RiverWay Clinics) (Family Practice); Dave Moen, MD (Fairview Lakes Regional Health Care) (Emergency Medicine); Barbara Bank, MD (Columbia Park Medical Group) (Family Medicine); Michael Cline, MD (HealthEast Care System) (Family Medicine); Therese Zink, MD, MPH (Fairview Redwing) (Family Medicine); Sonja Short, MD (Fairview Health Services) (Internal Medicine/Pediatrics); Renee Lipinski, RN (Allina Clinic) (Nursing); Kathy Hanson, MA, LP (Aspen Medical Group) (Psychology); Penny Fredrickson (Institute for Clinical Systems Improvement) (Measurement/Implementation Advisor); Pam Pietruszewski, MA (Institute for Clinical Systems Improvement) (Facilitator)

FINANCIAL DISCLOSURES/OTHER POTENTIAL CONFLICTS OF INTEREST

ADAPTATION

Measure was not adapted from another source.

RELEASE DATE

2003 Nov

REVISION DATE

2006 Sep

MEASURE STATUS

This is the current release of the measure.

This measure updates a previous version: Institute for Clinical Systems Improvement (ICSI). Domestic violence. Bloomington (MN): Institute for Clinical Systems Improvement (ICSI); 2004 Nov. 51 p.

SOURCE(S)

  • Institute for Clinical Systems Improvement (ICSI). Domestic violence. Bloomington (MN): Institute for Clinical Systems Improvement (ICSI); 2006 Sep. 46 p. [87 references]

MEASURE AVAILABILITY

NQMC STATUS

This NQMC summary was completed by ECRI on September 16, 2004. This summary was updated by ECRI on January 19, 2005 and again on December 6, 2006.

COPYRIGHT STATEMENT

This NQMC summary (abstracted Institute for Clinical Systems Improvement [ICSI] Measure) is based on the original measure, which is subject to the measure developer's copyright restrictions.

The abstracted ICSI Measures contained in this Web site may be downloaded by any individual or organization. If the abstracted ICSI Measures are downloaded by an individual, the individual may not distribute copies to third parties.

If the abstracted ICSI Measures are downloaded by an organization, copies may be distributed to the organization's employees but may not be distributed outside of the organization without the prior written consent of the Institute for Clinical Systems Improvement, Inc.

All other copyright rights in the abstracted ICSI Measures are reserved by the Institute for Clinical Systems Improvement, Inc. The Institute for Clinical Systems Improvement, Inc. assumes no liability for any adaptations or revisions or modifications made to the abstracts of the ICSI Measures.

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