Lowering the threshold for discussions of domestic violence - A randomized controlled trial of computer screening

Background: Women experiencing domestic violence (DV) frequent health care settings, but DV is rarely identified. Methods: We conducted a randomized controlled trial to determine the effect of computer screening on health care provider - patient DV communication at 2 socio-economically diverse emergency departments (EDs). Consenting nonemergent female patients, aged 18 to 65 years, were randomized to self- administered computer-based health risk assessment, with a prompt for the health care provider, or to "usual care"; all visits were audiotaped. Outcome measures were rates of DV discussion, disclosure, and services. Results: Of 2169 eligible patients, 1281 (59%) consented; 871 (68%) were successfully audiotaped, and 903 (71%) completed an exit questionnaire. Rates of current DV risk on exit questionnaire were 26% in the urban ED and 21% in the suburban ED. In the urban ED, the computer prompt increased rates of DV discussion (147/262 [56%] vs 123/275 [45%]; P=.004), disclosure (37/262 [14%] vs 23/275 [8%]; P=.07), and services provided (21 [8%] vs 10 [4%]; P=.04). Women at the suburban site and those with private insurance or higher education were much less likely to be asked about experiences with abuse. Only 48% of encounters with a health care provider prompt regarding potential DV risk led to discussions. Both inquiries about and disclosures of abuse were associated with higher patient satisfaction with care. Conclusions: Computer screening for DV increased but did not guarantee that DV would be addressed during ED encounters. Nonetheless, it is likely that low-cost interventions that allow patients the opportunity to selfdisclose can be used to improve detection of DV.