No More Missed Signs: Electronic Health Record Integration of Intimate Partner Violence Screening and Response in Primary Care
Abstract
Background: Intimate partner violence (IPV) is a serious public health issue; 1 in 2 transgender individuals, 1 in 3 women, and 1 in 4 men experience IPV in their lifetime. IPV has lasting physical and mental health effects, including headaches, abdominal pain, anxiety, and depression. UC San Diego Health (UCSDH), one of the major leaders in research and innovation in San Diego and globally, lacked IPV screening and response protocol. To close this gap, we conducted a literature review and environmental scan of electronic health record (EHR) tools to develop an outpatient IPV screening protocol and implemented it within outpatient clinics’ EHR.
Methods: Using previous validated IPV screening tools, conducting a literature review on environmental scan of clinical workflows and EHR tools, and collaborating with a multidisciplinary team of researchers and health providers, we integrated the Abuse Assessment Screen (AAS) IPV screening tool into UCSDH EHR. Twelve in-person training sessions were conducted with over 100 providers and 120 staff at each UCSDH Primary Care Clinic, and a corresponding UCLC Learning Module and Epic Tip Sheet was developed and disseminated widely. An IPV SmartSet was developed to support clinician response to positive screens as well as comply with mandated reporting obligations. IPV resources were included in all UCSDH After Visit Summaries, all keeping patient safety and privacy in mind. A community-academic partnership was developed with Your Safe Place, a local resource, to fill the Social Work gap in primary care. Staff feedback and experiences were collected through an online survey regarding implementation outcomes including acceptability and sustainability of IPV screening, using adapted version of the validated Physician Readiness to Manage Intimate Partner Violence Survey. Screening and positive rates were measured using the Epic SDOH Dashboard.
Results: Over 50 clinical staff members responded with 83% of staff stating that they were fairly or completely confident with caring for patients experiencing IPV compared to a confidence score of 24% prior to training. In the first 3 months after implementation (April – June 2024), the tool usage in clinic was tracked with an average of 1 – 5% of all patients surveyed experiencing some level of IPV. Qualitative survey results further showed that while some staff feel this is an additional burden of time on their job and potentially uncomfortable to administer, many staff feel this is crucial work to connect patients experiencing IPV to critical resources. Staff found the educational trainings helpful for implementation success. Since implementation in April 2024, primary care IPV screening rates increased from 0% to 32.63% over a 12-month period. IPV positive rates are around 2.86% as of March 2025.
Conclusion: There are several evidence-based approaches to effectively and safely implement IPV screening in the outpatient setting that directly address the gaps in identifying and responding to IPV at UCSDH. EHR can be carefully used as a tool to promote safe implementation of IPV screening and universal precautions. Overall, this pilot IPV screening and referral program is a significant step in the right direction to support patients experiencing IPV.