Electronic Health Record-Based Screening for Intimate Partner Violence: A Cluster Randomized Clinical Trial

Abstract

Importance: Intimate partner violence (IPV) is a significant public health issue, with a 25% lifetime prevalence. Screening for IPV in primary care is a recommended practice whose effectiveness is debated.

Objective: To assess the effect of an electronic health record (EHR)-based multifactorial intervention screening on the detection of IPV risk in primary care practice.

Design, setting, and participants: This cluster randomized clinical trial used a stepped-wedge design to assign 15 family medicine primary care clinics in the Medical University of South Carolina Health System in the Charleston region to 3 matched blocks from October 6, 2020, to March 31, 2023. All women aged 18 to 49 years who were seen in these clinics participated in this study.

Intervention: A noninterruptive EHR alert combined with confidential screening by computer questionnaire using the EHR platform followed by risk assessment and a decision support template.

Main outcomes and measures: The main outcomes were the rate at which patients were screened for IPV across the clinics and the rate at which patients at risk for IPV were detected by screening procedures.

Results: The study clinics cared for 8895 unique patients (mean [SD] age, 34.6 [8.7] years; 1270 [14.3%] with Medicaid or Medicare and 7625 [85.7%] with private, military, or other insurance) over the study period eligible for the screening intervention. The intervention had significant effects on the overall rate of screening for IPV, increasing the rate of screening from 45.2% (10 268 of 22 730 patient visits) to 65.3% (22 303 of 34 157 patient visits) when the noninterruptive alert was active (relative risk, 1.46 [95% CI, 1.44-1.49]; P < .001). The confidential screening process was more effective than baseline nurse-led oral screening at identifying patients reporting past-year IPV (130 of 8895 patients [1.5%] vs 9 of 17 433 patients [0.1%]).

Conclusions and relevance: The intervention was largely effective in increasing screening adherence and the positive detection rate of IPV in primary care. A highly private approach to screening for IPV in primary care may be necessary to achieve adequate detection rates while addressing potential safety issues of patients experiencing IPV.

Trial registration: ClinicalTrials.gov Identifier: NCT06284148.

Figure.. Randomized Stepped-Wedge Design With Clinics Identified

Green color indicates the active intervention phase.