Emilia H De Marchis1, Brigid McCaw2, Eric W Fleegler3, Alicia J Cohen4, Stacy Tessler Lindau5, Amy G Huebschmann6, Elizabeth L Tung7, Danielle M Hessler8, Laura M Gottlieb8. 1. Department of Family and Community Medicine, University of California San Francisco, San Francisco, California. Electronic address: emilia.demarchis@ucsf.edu. 2. California ACES Learning and Quality Improvement Collaborative (CALQIC), University of California San Francisco, San Francisco, California. 3. Division of Emergency Medicine, Boston Children's Hospital, Boston, Massachusetts; Department of Pediatrics and Emergency Medicine, Harvard Medical School, Boston, Massachusetts. 4. Center of Innovation in Long Term Services and Supports, VA Providence Healthcare System, Providence, Rhode Island; Department of Family Medicine, Alpert Medical School of Brown University, Providence, Rhode Island; Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, Rhode Island. 5. Department of Obstetrics & Gynecology, The University of Chicago, Chicago, Illinois; Department of Medicine-Geriatrics, The University of Chicago, Chicago, Illinois. 6. Division of General Internal Medicine, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado; Center for Women's Health Research, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado. 7. Department of General Internal Medicine, The University of Chicago, Chicago, Illinois. 8. Department of Family and Community Medicine, University of California San Francisco, San Francisco, California.
Abstract
INTRODUCTION: Screening for interpersonal violence is used in healthcare settings to identify patients experiencing violence. However, using unvalidated screening tools may misclassify patients' experience with violence. The Center for Medicare & Medicaid Innovation adapted a previously validated intimate partner violence screening tool for use in assessing interpersonal violence and retained the tool's original scoring rubric, despite the new tool's broader scope. This study evaluates the scoring system for detecting safety concerns. METHODS: This was a cross-sectional survey of a convenience sample of adult patients and caregivers of pediatric patients at 7 primary care clinics and 4 emergency departments (2018-2019). Surveys included the adapted 4-item Hurt Insult Threat Scream tool. Questions are scored by frequency on a Likert scale (1=never; 5=frequently). Scores of 11-20 are considered positive for safety concerns. Two-sided Fisher's exact tests were used for descriptive analyses. Data analyses occurred in 2019-2020. RESULTS: Of 1,014 participants, 66 (6.5%) reported any frequency of physical violence. Of these, 54 (81.8%) did not reach the threshold score of 11. Of the 1,014 participants, 93 (9.2%) reported any frequency of physical violence or being threatened with harm; 76 of 93 participants (81.7%) scored <11. CONCLUSIONS: Using the original scoring criteria for the adapted Hurt Insult Threat Scream, >80% of participants reporting physical violence did not screen positive for potential safety concerns. The scoring criteria did not reliably identify participants experiencing or at high risk for violence. To improve patient safety, the adapted Hurt Insult Threat Scream scoring rubric should be updated on the basis of stakeholder input and additional validation studies.
INTRODUCTION: Screening for interpersonal violence is used in healthcare settings to identify patients experiencing violence. However, using unvalidated screening tools may misclassify patients' experience with violence. The Center for Medicare & Medicaid Innovation adapted a previously validated intimate partner violence screening tool for use in assessing interpersonal violence and retained the tool's original scoring rubric, despite the new tool's broader scope. This study evaluates the scoring system for detecting safety concerns. METHODS: This was a cross-sectional survey of a convenience sample of adult patients and caregivers of pediatric patients at 7 primary care clinics and 4 emergency departments (2018-2019). Surveys included the adapted 4-item Hurt Insult Threat Scream tool. Questions are scored by frequency on a Likert scale (1=never; 5=frequently). Scores of 11-20 are considered positive for safety concerns. Two-sided Fisher's exact tests were used for descriptive analyses. Data analyses occurred in 2019-2020. RESULTS: Of 1,014 participants, 66 (6.5%) reported any frequency of physical violence. Of these, 54 (81.8%) did not reach the threshold score of 11. Of the 1,014 participants, 93 (9.2%) reported any frequency of physical violence or being threatened with harm; 76 of 93 participants (81.7%) scored <11. CONCLUSIONS: Using the original scoring criteria for the adapted Hurt Insult Threat Scream, >80% of participants reporting physical violence did not screen positive for potential safety concerns. The scoring criteria did not reliably identify participants experiencing or at high risk for violence. To improve patient safety, the adapted Hurt Insult Threat Scream scoring rubric should be updated on the basis of stakeholder input and additional validation studies.
Authors: Cynthia Feltner; Ina Wallace; Nancy Berkman; Christine E Kistler; Jennifer Cook Middleton; Collen Barclay; Laura Higginbotham; Joshua T Green; Daniel E Jonas Journal: JAMA Date: 2018-10-23 Impact factor: 56.272
Authors: Katherine M Iverson; Matthew W King; Megan R Gerber; Patricia A Resick; Rachel Kimerling; Amy E Street; Dawne Vogt Journal: J Trauma Stress Date: 2015-01-26
Authors: Susan J Curry; Alex H Krist; Douglas K Owens; Michael J Barry; Aaron B Caughey; Karina W Davidson; Chyke A Doubeni; John W Epling; David C Grossman; Alex R Kemper; Martha Kubik; Ann Kurth; C Seth Landefeld; Carol M Mangione; Michael Silverstein; Melissa A Simon; Chien-Wen Tseng; John B Wong Journal: JAMA Date: 2018-10-23 Impact factor: 56.272
Authors: Taressa K Fraze; Amanda L Brewster; Valerie A Lewis; Laura B Beidler; Genevra F Murray; Carrie H Colla Journal: JAMA Netw Open Date: 2019-09-04
Authors: Emilia H De Marchis; Danielle Hessler; Caroline Fichtenberg; Eric W Fleegler; Amy G Huebschmann; Cheryl R Clark; Alicia J Cohen; Elena Byhoff; Mark J Ommerborn; Nancy Adler; Laura M Gottlieb Journal: JAMA Netw Open Date: 2020-10-01