Intimate Partner Violence Screening for Women in the Veterans Health Administration: Temporal Trends from the Early Years of Implementation 2014-2020

ABSTRACT

Thousands of women Veterans experience intimate partner violence (IPV) each year. The Veterans Health Administration (VHA) has encouraged IPV screening in Veterans Affairs medical centers (VAMCs) since 2014. Through retrospective analysis of VHA administrative data from fiscal year (FY) 2014 into FY2020, we examined IPV screening implementation outcomes of reach and adoption, as well as screen-positive rates using descriptive and multivariate linear regression analyses. We examined reach and screen-positive rates overall and as a function of childbearing age (18–44 vs. 45+ years). In FY2014 only one VAMC was screening women for IPV; by FY2020, over half of VAMCs had adopted IPV screening. This rollout of IPV screening was associated with a large increase in the number of women primary care patients screened (from fewer than 500 in FY2014, to nearly 35,000 in early FY2020). Overall, among women screened, 6.7% screened positive for IPV; this rate was higher among women of childbearing age (8.1% vs. 5.6%). Despite the spread of IPV screening practices during the early years of implementation in VHA, additional work is needed. This study is the first comprehensive analysis of implementation outcomes associated with VHA’s IPV screening efforts, and lays the groundwork for ongoing evaluation and quality improvement.

KEYWORDS:

• Intimate partner violence
• screening
• implementation
• women veterans
• childbearing age
• primary care
• RE-AIM
• Veterans Health Administration

Acknowledgments

The study was supported by Department of Veterans Affairs, Office of Research and Development, Health Services Research & Development (HSR&D) Services Directed Research (SDR 18-150: Iverson & Miller).

Disclosure statement

Authors have no known conflict of interest to disclose.

Ethical Standards and Informed Consent

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation [institutional and national] and with the Helsinki Declaration of 1975, as revised in 2000.

Author Note

Christopher J. Miller, Center for Healthcare Organization and Implementation Research (CHOIR), VA Boston Healthcare System, Boston, MA and Department of Psychiatry, Harvard Medical School, Boston, MA; Kelly Stolzmann, Center for Healthcare Organization and Implementation Research (CHOIR), VA Boston Healthcare System, Boston, MA; Melissa E. Dichter, VA Center for Health Equity Research and Promotion (CHERP), Crescenz VA Medical Center, Philadelphia, PA and School of Social Work, Temple University, Philadelphia, PA; Omonyêlé L. Adjognon, Center for Healthcare Organization and Implementation Research (CHOIR) and Women’s Health Sciences Division, National Center for PTSD, VA Boston Healthcare System, Boston MA; Julianne E. Brady, Center for Healthcare Organization and Implementation Research (CHOIR) and Women’s Health Sciences Division, National Center for PTSD, VA Boston Healthcare System, Boston MA; Galina A. Portnoy, Pain Research, Informatics, Multimorbidities and Education (PRIME) Center, VA Connecticut Healthcare System, West Haven, CT and Department of Psychiatry, Yale School of Medicine, New Haven, CT; Megan R. Gerber, Division of General Internal Medicine, Albany Medical College, Albany, NY, VA Albany Healthcare System, Albany, NY and VA Boston Healthcare System, Boston, MA; Samina Iqbal, VA Palo Alto Healthcare System, Palo Alto, CA, Women’s Health Services, Veterans Health Administration, Washington, DC, and Division of Primary Care and Population Health, Stanford University School of Medicine; Katherine M. Iverson, Women’s Health Sciences Division, National Center for PTSD, VA Boston Healthcare System, Boston, MA and Department of Psychiatry, Boston University School of Medicine.

Additional information

Funding

The study was supported by Department of Veterans Affairs, Health Services Research & Development (HSR&D), Services Directed Research (SDR 18-150: Iverson & Miller). The funder did not have a say in the analyses or content of the present manuscript.