Transforming the Health Care Response to Intimate Partner Violence


Brigid McCaw, MD, MS, MPH; Lyn Yasumura, MD;
Tracy Flanagan, MD

Introduction: Intimate partner violence (IPV) is common and is associated with many health problems and increased health care utilization. Health care interventions can improve patient safety and outcomes, and the US Preventive Services Task Force recommends routine IPV screening for women.
Kaiser Permanente (KP) is the national leader in the health care response to IPV. Using an innovative systems model approach, performance improvement methodology, health information technology, and implementation science has resulted in significant and sustained improvement in addressing IPV.
Methods: The systems model includes four components: Supportive environment, clinician inquiry and brief intervention, referral to on-site behavioral health services, and community partnerships. Clinical workflows, training, and electronic health records (EHR) tools facilitate evaluation and referral. Quarterly reported metrics support performance improvement. Physician champions lead facility-based teams using a step-wise approach to implementation.
Results: As the systems model has been fully implemented in Medical Centers across KP Northern California (KPNC), there has been a 27-fold increase in IPV identification. As part of a 2010 strategic partnership between the KPNC IPV Champions and OB/Gyn Chiefs, IPV identification rate was added to the Womens Health Quality Dashboard, catalyzing rapid spread of best practices and significantly increasing IPV identification.
Discussion: In 2007, KP Interregional Family Violence Prevention (FVP) Physician Leaders adopted the systems model approach; developed clinical training, workflows and referral pathways; designed EHR tools; and created patient resource information, facilitating the implementation in other KP Regions.
In 2016, this group partnered with the Interregional (IR) OB/Gyn Chiefs. A common metric, IPV identification rate, was chosen to track progress across the Regions, and the IR OB/Gyn Chiefs selected improving IPV identification and response as a quality improvement initiative.
Conclusion: An interregional FVP leadership group has facilitated the spread of a successful KPNC approach to improving IPV identification and clinical care across KP. Now, a partnership with the IR Ob/Gyn Chiefs and the use of a programwide metric will advance the work further.


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