4005 — Development and Evaluation of a Clinical Decision Support Tool for Intimate Partner Violence Screening Among Women Veterans

Lead/Presenter: Fernanda Rossi,  COIN - Palo Alto
All Authors: Rossi FS (Center for Innovation to Implementation, Palo Alto), Wu J (Center for Innovation to Implementation, Palo Alto) Timko C (Center for Innovation to Implementation, Stanford University School of Medicine) Nevedal A (Center for Innovation to Implementation, Palo Alto) Wiltsey Stirman S (National Center for PTSD, Center for Innovation to Implementation, Stanford University School of Medicine)

Objectives:
Women veterans, compared to civilian women, are especially at risk of experiencing intimate partner violence (IPV). Despite a national rollout of IPV screening and intervention in VHA, a qualitative study examining women’s health primary care clinics across 11 VHA Medical Centers nationwide identified IPV screening and intervention implementation barriers such as providers’ inadequate IPV training, time constraints, and discomfort addressing IPV and making decisions about the appropriate type or level of intervention. To address such IPV screening implementation barriers, this study sought to: 1) describe the development of a novel IPV clinical decision support (CDS) tool for providers in the Women’s Health Clinic (WHC), a primary care clinic within the Veterans Affairs Palo Alto Heath Care System; and 2) obtain preliminary provider feedback on user experience and clinical utility of the tool. This tool provides intelligent, evidence-based, step-by-step guidance on how to conduct IPV screening and intervention with women veterans according to patient factors.

Methods:
Informed by existing CDS development frameworks, developing the IPV CDS tool involved six steps: 1) Identify scope of the tool; 2) Literature review and consultation with IPV experts; 3) Incorporate IPV-related VHA and clinic resources; 4) Identify CDS components; 5) Tool design; and 6) Initial revisions. We obtained provider feedback on the tool’s user experience and clinical utility by administering the System Usability Scale (SUS) and conducting semi-structured interviews with six WHC primary care physicians. SUS results were examined using descriptive statistics (scores >68 = above average tool usability). Interviews were analyzed using rapid qualitative analysis to extract actionable feedback to inform design updates and improvements.

Results:
This study includes a detailed description of the IPV CDS tool and its development. Providers indicated good tool usability (SUS score: M = 77.5, SD = 12.75). They stated the tool was clinically useful because it helps address anxiety about making appropriate IPV care decisions. They indicated the tool was needed in their practice, especially for providers less familiar with IPV care, as it increased their confidence in managing IPV. However, providers expressed concerns regarding the tool’s length (e.g., time consuming when encountering high risk patients), flexibility (e.g., could the tool be used for multiple purposes such as an educational tool for less experienced providers and a check list for more experienced providers), and specificity of information (e.g., need more tailored information such as list of local shelters).

Implications:
Provider feedback on the tool is encouraging for enhancing IPV screening and intervention among women veterans and will be used to improve the tool. This study offers an example of an IPV CDS tool that clinics can adapt to enhance the quality and efficiency of their IPV care process.

Impacts:
An interactive, step-by-step IPV CDS tool, such as the one described in this study, has yet to be adopted in the VHA and other health care systems more broadly, and holds considerable promise for ensuring efficient implementation of best IPV care practices and, consequently, improving the value, accessibility, and quality of healthcare delivered to women veterans and civilians.