CMIPS Seminar: "Mixed Methods Evaluation of a National Intimate Partner Violence Screening Expansion Implementation: Integrating RE-AIM and CFIR Frameworks"

The healthcare system plays an integral role in the detection and response of intimate partner violence (IPV), a significant public health problem with far-reaching consequences. The majority of IPV screening initiatives have historically targeted women of reproductive age, with little known about IPV screening experiences among other patient populations, including men. The Veterans Health Administration (VHA) has called for an expansion of IPV screening, providing a unique opportunity for a large-scale evaluation of IPV screening and response across patient populations. This presentation describes mixed-methods findings from a highly-partnered evaluation with VHA operations partners, guided by an integration of the RE-AIM and CFIR frameworks. Using medical record data from 6,970,533 patients (89.8% male) across 135 VHA facilities, we conducted analyses across RE-AIM components to examine the reach of IPV screening, including differences and disparities between those who were and were not screened across patient characteristics (e.g., gender, age, race, ethnicity, sexual orientation, marital status); effectiveness of screening; adoption across VHA facilities, provider types, and clinical settings; and implementation fidelity. Additionally, data from CFIR-grounded qualitative interviews with providers (n=32) and patients (n=37), helped us identify and categorize multilevel factors critical to screening expansion, potential barriers and enablers of implementation, and impact/effectiveness of screening on patient outcomes. Integrating RE-AIM and CFIR allowed for an in-depth and rich evaluation of the screening and response expansion. Findings yield clinical, policy, and research implications, including recommendations for screening implementation initiatives and/or adaptations, optimization of strategies for screening implementation across patient populations, and underscoring the value of integrating D&I frameworks for conducting rigorous evaluations.