Confidential screening tool for intimate partner violence 10 times more effective than traditional methods

EHR tool identifies IPV victims: ©Aungmyo - stock.adobe.com

South Carolina researchers have developed an EHR-based screening tool that is 10 times more effective than traditional methods in identifying victims of intimate partner violence (IPV). IPV includes physical and sexual violence, stalking, and psychological aggression by a current or former partner. The findings, published in JAMA Network Open, could change how health care providers identify and address IPV in primary care settings.

“There is an epidemic of intimate partner violence in South Carolina,” said Leslie A. Lenert, M.D., associate provost of Data Science and Informatics at the Medical University of South Carolina, in a statement.

The need for better IPV screening

Screening for IPV in primary care is recommended by the U.S. Preventive Services Task Force, as early detection can lead to support for those at risk. Yet, IPV screening is often underutilized in clinical settings, with many providers relying on oral screenings that lack privacy, making it difficult for patients to open up about their experiences.

“Victims in violent relationships are at risk for long-term psychological difficulties, like post-traumatic stress disorder,” said Alyssa A. Rheingold, Ph.D., a clinical psychologist and professor at MUSC’s Department of Psychiatry and Behavioral Sciences, in a statement. Children who witness domestic violence are also at risk for emotional and psychological challenges.

While both men and women can be affected by IPV, women are disproportionately impacted, and are more likely to suffer severe injuries or fatalities. To address this, the MUSC team focused their efforts on developing a screening tool specifically for women.

Developing a confidential, EHR-based solution

To tackle these challenges, Lenert partnered with Rheingold, family physician Vanessa Diaz, M.D., and health services researcher Kit N. Simpson, DrPH, to develop an EHR-based screening system that prioritized confidentiality and streamlined the process within clinical workflows.

The screener, designed to assess physical and sexual violence, was administered electronically to patients in primary care centers across South Carolina. Patients were handed a computer with a private questionnaire that they completed without their partners present, helping to ensure that victims felt safe and unjudged.

“We consulted with an advisory board of national experts, as well as an advisory board of victims and survivors of intimate partner violence, to gather their input on what screening tools would be the most successful,” Rheingold said.

The EHR system also ensured that sensitive information, such as the results of the IPV screening, was stored securely. Only the patient and provider could access the results, safeguarding the patient's privacy from potential abusers.

Empowering physicians and patients

Diaz, chief of MUSC’s Primary Care Integrated Center of Clinical Excellence, noted the importance of integrating the screener into daily clinical routines without adding to providers’ already demanding schedules. “It was important to give the patients a safe space through technology, where they felt comfortable answering these very personal and emotional questions,” Diaz said.

In addition to the new screening tool, providers were trained in best practices for discussing IPV and given resources for referring patients to support services. These efforts not only increased identification of IPV but also helped normalize the discussion of domestic violence in primary care.

Moving forward

The MUSC team said that this screening method is not a cure-all for intimate partner violence. However, they believe it is a critical first step in creating safer spaces for patients to share their experiences and seek help.

“We aim to make the doctor’s office a safe place where women can discuss IPV with their provider and move forward with the difficult task of escaping an abusive relationship,” said Lenert.

The researchers hope that their efforts will help bridge the gap in patient reporting and empower more women to seek the assistance they need.

“We recognize that most situations are complex,” added Rheingold. “We want people experiencing IPV to know that there is support available to help them to feel safe and get to a place of safety.”