A Validated Screening Instrument for Identifying Intimate Partner Violence in South Asian Immigrant Women.

Intimate partner violence (IPV) for South Asian immigrants is prevalent and has many unique sociodemographic and cultural factors associated with it. Current screening instruments do not address the unique cultural factors associated with IPV in this population. The South Asian Violence Screen (SAVS) is a 14-item screening tool for IPV designed based on the specific demographic and cultural issues affecting South Asian immigrant women in the United States. The tool was validated using the Index of Spouse Abuse (ISA), a well-established survey instrument for detecting IPV. The participants in the study included 116 South Asian immigrant women, who were recruited from a medical clinic and two community centers in Chicago, IL. With a prevalence of 23.3% of women reporting physical abuse and 28.4% reporting nonphysical abuse, the negative predictive value of the SAVS compared with the ISA was 0.99 and 0.97 for physical abuse and nonphysical abuse, respectively. When compared with the ISA-physical, the sensitivity and specificity were 0.96 and 0.87, respectively, and when compared with the ISA-nonphysical, the sensitivity and specificity were 0.94 and 0.92, respectively. This study demonstrates that the SAVS is an effective and efficient screening tool in the South Asian immigrant population in Chicago.

Assessing Intimate Partner Violence in South Asian Women Using the Index of Spouse Abuse.

Intimate Partner Violence (IPV) affects 21-40% of South Asian (SA) women in the United States. No screening tool has been validated in this population. This study sought to determine the validity of the Index of Spouse Abuse (ISA) as an IPV screening tool and to determine the prevalence of IPV among a SA immigrant population. Thirty-one percent of women screened positive on one or both ISA scales. The ISA-P and ISA-NP items were highly reliable as was the correlation between the ISA-P and ISA-NP scores. The ISA is a valid and reliable IPV screening tool in the SA immigrant population.

"Patients who can't get an appointment go to the ER": access to specialty care for publicly insured children.

STUDY OBJECTIVE: Emergency departments (EDs) frequently refer patients for needed outpatient specialty care, but little is known about the dynamics of these referrals when patients are publicly insured. Hence, we explored factors, including the role of ED referrals, associated with specialists' willingness to accept patients covered by Medicaid and the Children's Health Insurance Program (CHIP). METHODS: We conducted semistructured qualitative interviews with a purposive sample of 26 specialists and 14 primary care physicians in Cook County, Illinois, from April to September 2009, until theme saturation was reached. Transcripts and notes were entered into ATLAS.ti and analyzed using an iterative coding process to identify patterns of responses, ensure reliability, examine discrepancies, and achieve consensus through content analysis. RESULTS: Themes that emerged indicate that primary care physicians face considerable barriers getting publicly insured patients into outpatient specialty care and use the ED to facilitate this process. Specialty physicians reported that decisions to refuse or limit the number of patients with Medicaid/CHIP are due to economic strain or direct pressure from their institutions. Factors associated with specialist acceptance of patients with Medicaid/CHIP included high acuity or complexity, personal request from or an informal economic relationship with the primary care physician, geography, and patient hardship. Referral through the ED was a common and expected mechanism for publicly insured patients to access specialty care. CONCLUSION: These exploratory findings suggest that specialists are willing to see children with Medicaid/CHIP if they are referred from an ED. As health systems restructure, EDs have the potential to play a role in improving care coordination and access to outpatient specialty care.

Detection of intimate partner violence in a general medicine practice.

In this study, an assessment phase is undertaken to determine intimate partner violence (IPV) prevalence. An anonymous survey is followed by a chart review documenting identification of IPV. Two methods are attempted to increase assessment/documentation of IPV: a physician educational intervention and a nursing routine inquiry intervention in one quadrant of the practice. The IPV physician educational intervention includes didactic sessions, an IPV counselor, and resource information. The routine inquiry intervention involves nurses screening female patients for IPV at check-in. IPV is found to be prevalent in a general medicine clinic. An enhanced educational intervention does not increase IPV documentation. A routine inquiry intervention significantly increases documentation of lifetime IPV but does not impact current IPV identification.

Gaps in pediatric clinician communication and opportunities for improvement.

Teamwork and good communication are central to the provision of high-quality care. A standardized focus-group protocol was used. Analysis assessed emergent themes of patient safety-related effective and problematic clinician communication. Sixty-three focus groups were conducted with clinicians from five Chicago Pediatric Patient Safety Consortium hospitals. Effective and problematic clinician-to-clinician communication themes were described in all focus groups and at each participating hospital. Problematic communication contexts included the communication process for orders, consultations, acuity assessment, management of surgical and medical patients, and the discharge process. Organizational policies and systems leading to patient safety risk included a lack of clear responsibilities and expectations for clinicians and for clinical communication, as well as a lack of a clear chain of responsibility for communication when hierarchical communication barriers affected safe patient care. Results of this investigation highlighted gaps in pediatric clinician communication and opportunities for improvement.