Documenting Intimate Partner Violence Domestic Violence Screening in RPMS

1
Documenting Intimate Partner Violence/Domestic
ViolenceScreeningin RPMS

• Introducing the RPMS
• IPV/DV Screening Exam Code

2
GPRA (CIRS) Domestic Violence Indicator

• During FY 2005, the IHS will ensure that 15 of
  women between the ages of 15 and 40 are screened
  for domestic violence.
• During FY 2004, the IHS will address domestic
  violence, abuse and neglect by screening at least
  15 of eligible women patients between the ages
  of 16-24 for domestic violence at direct care
  facilities

3
Clinical Objectives

• Objective IPV/DV Screening
• Standard Adult females should be screened for
  domestic violence at a new encounter and at least
  annually prenatal once each trimester (Source
  Family Violence Prevention Fund National
  Consensus Guidelines)

4
Why Screen?

• US Preventive Services Task Force (USPTF)
  acknowledges that the effectiveness of screening
  has not been validated, however, they also state
  that screening is justifiable on other grounds
  including
• High prevalence of undetected abuse among female
  patients
• Low cost and low risk of screening
• Adverse economic and social impact of abuse
• DV is a chronic, life-threatening condition that
  is treatable if abuse is left untreated the
  severity and frequency of abuse can worsen

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Why Screen?

• DV screening is recommended by
• American Academy of Family Physicians
• American College of Physicians
• American Medical Associations
• American College of Obstetricians and
  Gynecologists
• DV Screening is a JCAHO Mandate
• JCAHO Mandate
• GPRA Clinical Performance Indicator
• Women want to be asked!

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RPMSIPV/DV ScreeningExam Mnemonic EX 34 or
IPV Screen

• AUM 4.1 Patch 1 AUPN Patch 11 Released Nov 03

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IPV/DV Screening in RPMS

• IPV/DV Screening will be conducted as an exam
  within a visit
• Providers should work with Data Entry staff to
  ensure that proper documentation and coding
  occurs
• Screening results can be entered on a PCC
  (patient encounter) with a stamp or pre-print
  Behavioral Health providers can enter
  electronically via the RPMS BH applications

8
Current IPV/DV Screening Exam Code Data Entry

• Exam Mnemonic EX 34 or IPV Screen (AUM 4.1
  patch 1 AUPN patch 11)
• Allowable results
• N Negative
• PR Present
• PA Past

9
EX 34Data Entry

• Refusals Mnemonic REF
• Exam
• Exam Value INT (or INT)
• Date Refused

10
EX 34Data Entry

• Unable to Screen
• Mnemonic UAS (PCC Data Entry patch 7)
• Exam
• Exam Value INT (or 34)
• Date Refused

11
IPV/DV Screening Exam Code 34Provider
Documentation

• EXAM DV (or IPV) Screen
• Negative denies being a current or past victim
  of DV
• Present admits being current victim of DV
• Past denies being a current victim, but admits
  being a past victim of DV

12
Provider DocumentationContinued

• Providers should always document unsuccessful
  attempts to screen using the mnemonics REF and
  UAS
• Refused patient declined exam/screen
• Unable to screen -- acceptable reasons for UAS
  include partner present, verbal child present

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Proposed RPMS IPV/DV Screening Documentation and
Data CollectionImprovements

• IPV/DV Screening Exam Code
• PCC Management Reports
• Health Maintenance Reminder

14
Requested Enhancements to IPV/DV Screening Exam
Code

• Initials who administered the exam (Ordering
  Provider added to DE template)
• Capture comments (245 characters)
• for Exam results (Negative, Present, Past)
• for Refusal
• for Unable to Screen

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PCC Management ReportsIPV/DV Requests

• Date Range
• Age Range
• Count by Provider
• Count by Response (N, PR, PA)
• List of Exam Results with comments (Do we want
  option of listing with patient identifier?)
• Sort by ?? (community, tribe, location of
  encounter, clinic, etc.)
• Need firm specifications for programmer

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Development of IPV/DV Health Maintenance Reminder

• Display on Health Summary
• Screen on Gender
• Screen on Age
• Screen on current dx of pregnancy key off of EDC
  (problematic because of persistent data)
• Frequency Standard is annual once per
  trimester for prenatal