Lowering the Threshold for Discussions of Domestic Violence: A Randomized Controlled Trial of Computer Screening | Emergency Medicine | JAMA Internal Medicine | JAMA Network
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Original Investigation
May 22, 2006

Lowering the Threshold for Discussions of Domestic Violence: A Randomized Controlled Trial of Computer Screening

Author Affiliations

Author Affiliations: Department of Medicine, Section of Emergency Medicine (Drs Rhodes and Howes and Ms Anliker) and Department of Health Studies (Dr Drum), University of Chicago, Chicago, Ill; Indiana University School of Medicine, Regenstrief Institute, Health Services Research and Development, and Richard L. Roudebush Veterans Affairs Medical Center, Indianapolis (Dr Frankel); and Department of Medicine, University of Toronto, Toronto, Ontario (Dr Levinson). Dr Rhodes is now with the Department of Emergency Medicine, University of Pennsylvania Hospital, Philadelphia.

Arch Intern Med. 2006;166(10):1107-1114. doi:10.1001/archinte.166.10.1107

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.