MANAGED CARE March 2007. ©MediMedia USA
Implementing what was formerly called the Chronic Care Model can improve an organization's response to this widespread problem
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Abstract
Purpose: This article presents the steps for organizing a health organization's response to intimate partner violence (IPV) according to the Planned Care Model (PCM). IPV is common and costly and results in poor physical and mental health outcomes for victims and their families. Because most care is not acute, a planned approach that crosses systems may result in more comprehensive and higher quality care. Community collaboration with IPV agencies is especially critical. The health care organization must make IPV a priority and set policies and systems to identify and manage patients, train staff, and measure, monitor, and provide feedback on outcomes. Other key PCM components include: practice design — design systems to identify and track victims, stratify risk, and coordinate care; evidence-based decision support — choose validated IPV screening questions and guidelines for identification, management, and referral and make them available in a systematic way with ongoing assessment and feedback to providers and other members of the health care team; patient self-management — self-management materials should be selected and disseminated to those working with IPV victims; and data information systems — these should support a confidential patient registry and efforts to audit and provide feedback about identification and referral efforts. Process and outcome measures based on the management guidelines and protocols should be developed and monitored, and the results disseminated.
Conclusion: Adapting PCM for the management of IPV stretches the traditional acute approach to IPV of screen-identify-refer. It expands the PCM into new realms, including embracing new partners, trying innovative ways to measure return on investment, grappling with ethical dilemmas, and designing a multifactorial evaluation across systems.
Key words: domestic violence, intimate partner violence, chronic care model, planned care model.
Author correspondence:
Therese Zink, MD, MPH
Department of Family sand Community Medicine
University of Minnesota
MMC 81
420 Delaware Street SE
Minneapolis, MN 55455