title: Individualized performance feedback to increase prenatal domestic violence screening.
abstract: OBJECTIVE
  Universal domestic violence (DV) screening once per trimester of pregnancy is recommended but rarely accomplished. Clinical leaders in this setting sought to improve adherence with this protocol. This prospective study used medical record audit and individualized performance feedback with peer comparison (IPF) to improve DV screening among first and second year obstetrics and gynecology (ob/gyn) residents.
  
  
  METHODS
  The setting is a northeastern, urban, hospital-based, prenatal clinic serving low-income women. Most patients are Latina (75%); 11% are black and 9% are white. Few begin care in the first trimester (8.5%). We gave all residents DV training. Next we gave IPF-four reports at seven-week intervals. We reviewed medical record notes on patient visits corresponding to the first medical encounter and week 16 and week 28 of pregnancy. We used this data to compare screening immediately before IPF and following each IPF report.
  
  
  RESULTS
  Screening increased steadily over time, from 60% of appropriate visits before IPF to 91% after the fourth report (Chi Square 28.4, p<.001). Adjusting for key factors, the odds of screening after the last IPF report were seven and a half times greater than the odds of screening before IPF (Odds Ratio: 7.6; 95% Confidence Interval: 3.0, 19.0).
  
  
  CONCLUSIONS
  IPF was associated with increased DV screening among first and second year ob/gyn residents in this setting. Increased screening improved compliance with the clinic protocol and increased opportunities for patient disclosure, education, and treatment, critical public health objectives.
authors.affiliation: Community Medicine and Health Care, University of Connecticut Health Center, Farmington, CT, USA. mmduncan@mail.computer.net
authors.forename: Mary M
authors.initials: MM
authors.lastname: Duncan
authors.forename: Patricia A
authors.initials: PA
authors.lastname: McIntosh
authors.forename: Catherine D
authors.initials: CD
authors.lastname: Stayton
authors.forename: Charles B
authors.initials: CB
authors.lastname: Hall
mesh_terms: D016009:Chi-Square Distribution; D003237:Connecticut; D017579:Domestic Violence; D005246:Feedback; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D008403:Mass Screening / Q000706:statistics & numerical data*; D008485:Medical Audit / Q000379:methods*; D009774:Obstetrics / Q000193:education / Q000592:standards; D010044:Outpatient Clinics, Hospital / Q000592:standards*; D010818:Practice Patterns, Physicians'; D011247:Pregnancy; D011295:Prenatal Care / Q000592:standards*