Using new questions, U clinics probe for domestic partner violence

Doctors and nurses often use the catchall question, "Do you feel safe at home?" to assess patients for domestic violence, but the University of Minnesota is studying a more deliberate approach to identify patients who might be hesitant or afraid to admit to abuse.

Since November, caregivers at the U's ambulatory care center have been asking four questions to probe for humiliation, fear, physical abuse or sexual assaults that patients have suffered at the hands of spouses or intimate partners.

"It's harder to escape those questions," said Dr. Mary Logeais, a primary care doctor leading the research.

The study, which took advantage of federal grants to study intimate partner violence, or IPV, has resulted in anecdotal cases of patients acknowledging violence and getting help. Its initial successes will be featured this week at a conference hosted by the Bloomington-based Institute for Clinical Systems Improvement to highlight promising health care reforms.

IPV in Minnesota causes about 1,000 adult hospitalizations every year, according to Department of Health data, making it a medical issue as well as a public-safety concern. Logeais' study will track whether use of the new questions results in better overall health for patients over time and reduces their use of emergency departments and urgent care clinics.

"Violence leads to a lot of adverse health effects, both physically and mentally, and increased health care utilization such as emergency services and recurrent office visits," Logeais said,

The Joint Commission, an influential national health care accrediting body, requires that doctors ask patients about their safety. But Logeais said the query can get buried in the rush of questions about diet, exercise and other measures of health.

The study is based on the proven HARK (Humiliation, Afraid, Rape, Kick) questionnaire, though an abrupt question about rape was modified to be less jarring.

Training clinic staff how to approach patients with the questions was only the first step, Logeais said. If patients acknowledge violence, she said, caregivers can't send them home with a shiny pamphlet saying "So you're a victim of intimate partner violence …"

With support and advice from the Domestic Abuse Project of Minneapolis, clinic staff have learned how to give patients confidential help, such as emergency phone numbers written on innocuous scraps of paper or hidden in their mobile phone contact lists.

The study isn't limited to primary care; specialists also ask the questions.

"We really thought it was important to ask everywhere," Logeais said, "because people might show up in an eye clinic with a black eye or an orbital fracture from being assaulted."