AHCPR-Sponsored Research on Women's Health
Non-medical factors, including race, region, and sex of the patient's physician affect hysterectomy rates.
Hysterectomy is the second most frequently performed major operation in the United States, with about 590,000 procedures performed each year. Annual costs exceed $5.0 billion.
By age 60, more than one-third of women in the United States have had a hysterectomy. A review article on indications for hysterectomy found that women who live in the Southern and Midwestern areas of the United States, African-American women, and women who have male gynecologists are more likely to have hysterectomies.
Carlson KJ, Nichols DH, Schiff I. Indications for hysterectomy. N Engl J Med 328(12):856-860, 1993. (Grant No. HS-O6121).
African-American women are more likely than white women to have a hysterectomy, are hospitalized longer, and are at higher risk for complications and death.
Based on 1986 to 1991 hospital data from the State of Maryland, researchers found that African-American women are 25 percent more likely to have a hysterectomy than white women of the same age. The study also indicated that African-American women having the procedure were more likely to have complications, remained hospitalized longer, and had a higher risk of death.
Kjerulff K, Guzinski G, Langenberg P, et al. Hysterectomy and race. Obstet Gynecol 82(5):757-764, 1993. (Grant No. HS-06865).
Hysterectomy improves quality of life for some women.
In a study of 418 women, hysterectomy was found to be highly effective for relief of pelvic pain, fatigue, depression, sexual dysfunction, and other symptoms associated with nonmalignant conditions of the uterus. Researchers from the Maine Medical Assessment Foundation, Harvard Medical School, and Massachusetts General Hospital concluded that hysterectomy provided significant relief and an improved quality of life 1 year postoperatively.
A limited number of women reported new problems, including hot flashes (13 percent), weight gain (12 percent), depression (8 percent), anxiety (6 percent), and lack of interest in sex (7 percent).
Carlson KJ, Miller BA, Fowler FJ Jr. The Maine Women's Health Study I: Outcomes of hysterectomy. Obstet Gynecol 83(4):556-572. (Grant No. HS-06121).
Hysterectomy for three nonmalignant gynecological conditions is associated with greater improvement in symptoms and quality of life than medication or "watchful waiting."
In this component of the Maine Women's Health Study, the health outcomes of 380 women treated non-surgically for conditions of the uterus, including uterine fibroids, abnormal bleeding and/or chronic pain, were compared with those of 311 women who had hysterectomies for similar conditions. Even after controlling for age, reproductive history, and severity of symptoms, hysterectomy was the most highly correlated with a positive outcome at 1 year.
Of the women treated non-surgically at the outset, one-fourth underwent a hysterectomy within a year. Many of the women treated with medications experienced a significant reduction in abnormal bleeding and chronic pelvic pain, although problems continued in an appreciable number of others.
Women with uterine fibroids whose physicians prescribed "watchful waiting" experienced no significant change in symptoms or decline in quality of life, providing some reassurance to women who are asymptomatic or have mild symptoms and choose to avoid surgery.
Carlson KJ, Miller BA, Fowler FJ Jr. The Maine Women's Health Study II: Outcomes of nonsurgical management of leiomyomas, abnormal bleeding, and chronic pelvic pain. Obstet Gynecol 83(4):556-572. (Grant No. HS-06121).
Hysterectomy is not associated with severe depression in older women.
In a retrospective study of 1,074 upper-middle class, older women interviewed between 1984 and 1987, findings suggest that bilateral oophorectomy (removal of both ovaries) is associated with only slight increases in depression scores. The authors recommend prospective studies to examine the risk of depression in response to hysterectomy, oophorectomy, and estrogen replacement therapy.
Kritz-Silverstein D, Wingard DL, Barrett-Connor E, et al. Hysterectomy, oophorectomy, and depression in older women. Journal of Women's Health 3(4):255-263, 1994. (Grant No. HS-06726).
Studies in Progress
Do race and socioeconomic factors affect the decision to have a hysterectomy and outcomes of the procedure?
This AHCPR-supported research is examining the extent to which a patient's race and other socioeconomic factors affect both the decisionmaking process of whether to have a hysterectomy and the outcomes of the surgery. Kristin Kjerulff, Principal Investigator (Grant No. HS-O6865).
Evaluation of alternatives to hysterectomy for treatment of fibroids and other benign conditions of the uterus.
The Agency has announced the availability of funds for multi-year clinical trials which would assess the effectiveness and costs of alternatives to abdominal hysterectomy. Alternatives to be studied will include drug treatments, limited surgery, watchful waiting, and other less invasive treatment approaches to non-cancerous conditions of the uterus. Studies are expected to begin by September 1996 and to be completed within a 5-year period.
Clinical Practice Guideline: Quality Determinants of Mammography.
The Clinical Practice Guideline presents a broad view of mammography services, starting from when a provider calls to schedule mammography to the tracking, monitoring, and followup of the screened patient. The companion Quick Reference Guide outlines seven steps to breast health for women, and provide guidance for clinicians who refer women for screening or diagnostic mammography. AHCPR, October 1994.
Women treated in urban hospitals for early-stage breast cancer are nearly twice as likely as those in rural hospitals to have breast-conserving surgery instead of radical mastectomy.
1981 to 1987 discharge data from the Hospital Cost and Utilization Project on women surgically treated for early-stage breast cancer shows that those in urban hospitals are nearly twice as likely to have a breast-conserving procedure as are women in rural hospitals. Urban hospital patients are 40 percent less likely to have a radical mastectomy than are their rural counterparts.
The researchers suggest that this variation may be attributable to the limited access to teaching hospitals and oncology services in rural areas, and differences in patient preferences.
Johantgen ME, Coffey RC, Harris DR, et al. Treating early-stage breast cancer: hospital characteristics associated with breast-conserving surgery. Am J Public Health 85(10):1432-1434, 1995.
Women with early-stage breast cancer treated in teaching hospitals are nearly three times more likely to have breast-conserving surgery as those in non-teaching hospitals.
A study of the factors contributing to variation in the surgical treatment of early-stage breast cancer in Colorado shows that women treated in hospitals with any intern or resident program are almost three times as likely to have breast-conserving surgery as those in hospitals with no teaching programs.
Other factors that significantly increase the likelihood of receiving a breast-conserving procedure include: having surgery in the fall months; being in a high- or medium-occupancy hospital; and being in a hospital located in a metropolitan area. The presence of metastases or co-morbidity, and having Medicaid insurance significantly decrease the likelihood.
Johantgen ME. Understanding variation in the surgical treatment of early-stage breast cancer. Dissertation Abstracts International (doctoral dissertation, Virginia Commonwealth University, 1994).
Studies in Progress
Breast cancer treatment for older women.
More than 80,000 older women are diagnosed with breast cancer each year, of whom almost 70 percent are in early stages of the disease. Medicare alone spends in excess of $500 million per year for their care.
In 1990, a National Institutes of Health Consensus Panel recommended that, with few exceptions, the preferred treatment for localized breast cancer should be breast-conserving surgery accompanied by lymph node dissection and radiation therapy. Despite these recommendations, the use of breast-conserving surgery in patients older than age 65 varies considerably.
This 5-year study of the cost effectiveness of alternative therapies for treating older women with early-stage breast cancer is completing its first year. The project will survey older women in order to learn their role in making treatment decisions, their treatment preferences, and how they assess their quality of life. These considerations will be factored into the cost-effectiveness analysis.
Participating cancer centers include the Lombardi Center at Georgetown University, Howard University, and the Washington Hospital Center, in Washington, DC; the Dana Farber Cancer Institute/Harvard; the M.D. Anderson Cancer Center/University of Texas; and the Roswell Park Cancer Institute, Buffalo, NY. Jack Hadley, Principal Investigator (Contract No. HS-08395).
Pelvic Inflammatory Disease
Study in Progress
A clinical trial is comparing the effectiveness and cost effectiveness of outpatient and inpatient therapies recommended for treating pelvic inflammatory disease (PID).
PID affects more than one million American women every year, and frequently results in infertility, ectopic pregnancy, and chronic pelvic pain. The costs associated with PID and its consequences are estimated to exceed $4.0 billion annually.
In this study, conducted at five medical centers by University of Pittsburgh researchers, 1,200 women suspected of having PID will be assigned randomly either to inpatient parenteral treatment or to outpatient oral antibiotic therapy. The study will compare the time it takes for women to attain fertility, the rates of involuntary infertility, and the direct and indirect costs of treatment for each group. Roberta Ness, Principal Investigator (Grant No. HS08358).
Health Care Quality and Access for Women
Women are 25 percent less likely than are men to be included in clinical trials of thrombolytic therapy for heart attacks, despite few differences in trial eligibility.
Researchers developing a clinical model to identify those patients most likely to benefit from thrombolytic therapy for acute myocardial infarction found that women were 25 percent less likely to be included in clinical trials. To counter bias introduced by the exclusion of women from trials, it was necessary to supplement the data base with information on patients from non-trial settings.
Maynard C, Selker HP, Beshansky JR, et al. The exclusion of women from clinical trials of thrombolytic therapy: implications for developing the thrombolytic predictive instrument data base. Clinical Decision Making 15:38-43, 1995. (Grant No. HS-06208).
Female heart bypass patients are twice as likely as males to die in the hospital.
Researchers with the Ischemic Heart Disease Patient Outcomes Research Team (IHD PORT) conducted a prospective study of 3,055 patients receiving coronary artery bypass graft operations between 1987 and 1989. Differences in patients, disease stage, and treatment factors were examined to assess the underlying reasons for the higher hospital mortality rates reported for women.
The study found a mortality rate of 7.1 percent for women versus 3.3 percent for men. The mortality rate was higher for women in all age groups, as well as higher for emergency, urgent, and elective surgeries. A larger percent of women had surgery on an urgent basis.
Twenty-five percent of the excess risk was accounted for by older age at admission, greater co-morbidity, and greater severity of heart disease among women admitted for surgery. Remaining risk was the consequence of heart failure and hemorrhage, attributed to the smaller size of arteries in women and an absence of optimal artery grafting. The authors also cite studies which indicate that women with suspected coronary artery disease are less frequently referred for angiography than are men.
O'Connor GT, Morton JR, et al. Differences between men and women in hospital mortality associated with coronary artery bypass graft surgery. Circulation 88(5):2104-2110, 1993. (Grant No. HS-06503).
Female physicians are more likely to provide their patients with Pap tests and mammograms than are male doctors.
These findings, based on AHCPR's 1987 National Medical Expenditure Survey, take into account differences in age, race, education, lifestyle, and other factors.
Franks P, Clancy C. Physician gender bias in clinical decisionmaking: screening for cancer in primary care. Med Care 31(3): 213-218, 1993. (Contract No. HS 282-86-0013).
Women with health insurance have higher rates of C-section births.
This study analyzed California hospital discharge data on hospital deliveries from 1983 and 1990. The number of C-sections declined from a high of 25 percent in 1987 to 22.7 percent in 1990. Rates declined for all racial, ethnic, and maternal age groups, despite an increasing number of deliveries among women at least 35 years old and women with previous C-section deliveries.
Women covered by the Kaiser health maintenance organization or Medicaid (Medi-Cal) had substantially lower rates, which also declined faster than rates for women with private fee-for-service health insurance. Researchers attribute the overall decline in C-section rates to changing reimbursement policies and increasing public awareness of C-section practices.
Stafford RS, Sullivan SD, Gardner LB. Trends in cesarean-section use in California. Am J Obstet Gynecol 168:1297-1302, 1993. (Grant No. HS-06642).
Race, sex, and other nonclinical factors influence the likelihood of cataract surgery among Medicare beneficiaries.
The Cataract Patient Outcomes Research Team (PORT) conducted a cross-sectional, population-based study which analyzed administrative data on a random 5-percent sample of 1986 and 1987 Medicare beneficiaries. Findings indicated:
Women are about 18 percent more likely than men to undergo cataract surgery.
White Medicare beneficiaries are 27 percent more likely than black beneficiaries to undergo surgery. Despite the fact that black persons have a fourfold higher prevalence of cataract blindness, a black male is only 57 percent as likely to undergo cataract surgery as a white female.
Other factors strongly associated with cataract surgery were geographic area (tenfold higher in areas having more sunlight with an ultraviolet-B component); the Medicare payment rate (50 percent more likely in the areas with highest allowed charges than in areas with the lowest); and the concentration of optometrists (37 percent higher).
Javitt JC, Kendix M, Tielsch JM, et al. Geographic variation in utilization of cataract surgery. Med Care 33(1):90-105, 1995. (Grant No. HS-06280).
Women with AIDS receive fewer health care services than men with AIDS, even after taking into account income, race, insurance status, and geography.
This analysis of 1991 data from the AIDS Cost and Services Utilization Survey (ACSUS) found that women and adolescent girls infected with the human immunodeficiency virus (HIV) receive fewer medical services (such as medications, hospital admissions, and outpatient visits) than similarly diagnosed men.
An asymptomatic HIV-infected female is 20 percent less likely to receive AZT than an asymptomatic, HIV-infected male.
A female with acquired immunodeficiency syndrome (AIDS) is 20 percent less likely to be hospitalized for AIDS-related conditions than a male injection drug user.
It is unclear why females with AIDS receive fewer health services, even after adjusting for income, race, insurance, and geographic differences. The author notes that this phenomenon may merely reflect that women have more child care and other family responsibilities that may impede their abilities to avail themselves of health services, but discrimination against women with HIV could be another factor.
Hellinger FJ. The use of health services by women with HIV infection. Health Serv Res 28(5):543-561, 1993. (Contract No. HS-282-89-0020).
Low-income Mexican-American women use less prenatal care than white women, even under a managed care system with no co-payments.
This study found that pregnant Mexican-American women enrolled in Arizona's Medicaid managed care program averaged 24 percent fewer prenatal visits than white women, even when prenatal and well-child visits had no co-payment and when reimbursement for transportation was provided.
Moore P, Hepworth JT. Use of perinatal and infant health services by Mexican-American Medicaid enrollees. JAMA 272(4):297-304, 1994. (Grant No. HS-05518).
Studies in Progress
The role of physician decisions in limiting access to treatments for coronary artery disease among women and minorities.
This study, underway at Georgetown University in Washington, DC, and the University of Pennsylvania, will explore why there are widely reported differences in medical treatments, particularly cardiac procedures, for patients of different race and sex. The project will provide insight into the role of physician decisionmaking in limiting access to treatments for coronary artery disease among African Americans and women. Kevin A. Schulman, Principal Investigator (Grant No. HS-O7315).
The influence of the sex, age, race, and income of Medicare patients in obtaining access to kidney transplant waiting lists.
The objective of this project is to assess the extent of the influence of factors such as age, sex, race, and income on the equity of access to kidney transplant waiting lists for Medicare patients. Ronald Zminkowski, Principal Investigator (Grant No. HS-O7538).
Equity of access to "high-tech" surgical procedures, by sex, ethnicity/race, and/or insurance status.
This study will assess whether a patient's sex, ethnicity, and/or insurance status influence(s) the likelihood of receiving high-tech surgical treatments. Researchers will analyze whether there are variations in use of specific procedures, and whether variations are related to the technological characteristics of the procedure or other factors. Mita A. Giacomini, Principal Investigator (Grant No. HS-O7558).
The impact of poverty, rural residence, and minority status on the types and levels of obstetrical services received in low-risk pregnancies.
Low-income and minority women receive less prenatal care and have poorer birth outcomes than white and middle-class women. However, little is known about the content of prenatal care they receive. This study is assessing the extent to which poverty, minority status, and rural location affect the type and volume of obstetrical services received by low-risk pregnant women in the State of Washington. L. Gary Hart, Principal Investigator (Grant No. HS-O7412).
Evaluation of whether wealthy patients receive better care for heart disease than non-wealthy patients.
This study will assess whether coronary artery bypass surgery and angioplasty are underused for African Americans, women, and poor persons with heart disease. Conversely, it will examine also whether such procedures are overused for whites, men, and wealthier patients. Arnold M. Epstein, Principal Investigator (Grant No. HS-O7098).
Pregnancy, Birth Outcomes, and Family Planning
Hospital-based managed care plans reduce costs and shorten stays for C-section patients while increasing patient satisfaction.
Researchers at the University of Iowa compared patient outcomes and costs of care before and after implementing a hospital-based managed care plan. The managed care plan used a nurse case-manager along with a CareMap, used to organize and sequence obstetrical care. The CareMap also outlined expected problems, needed tests, medications, discharge planning, and other services.
The average length of stay for women in the managed care plan decreased by 13.5 percent (from 5.35 days to 4.62 days), as did postoperative costs, (from $3,950 to $3,432). Measures of patient satisfaction increased, and both complication rates and physical recovery scores at the time of discharge were similar in both groups. However, the physical recovery scores at 1 month were less positive in the managed care group, suggesting the need for supplemental care in the early discharge group.
Blegen MA, Reiter RC, Goode CJ, Murphy RR. Outcomes of hospital-based managed care: a multivariate analysis of cost and quality. Obstet Gynecol 86:809-814, 1995. (Grant No. RO3-7408).
Epidural analgesia is associated with a 10-percent increase in C-section rates.
A meta-analysis of studies (using the MEDLINE data base for 1981 through 1992) found a consistent association between use of epidural analgesia and C-section delivery. Further study of whether this is a cause and effect relationship is needed, along with research on risk-reduction techniques, examination of short and long-term maternal and fetal outcomes, assessment of the financial impact of C-section delivery, and a risk-benefit analysis of use of epidurals.
Morton SC, Williams MS, Keeler EB, et al. Effect of epidural analgesia for labor on the cesarean delivery rate. Obstet Gynecol 83(6):1045-1052, 1994. (Management and Outcomes of Childbirth PORT, Contract No. HS-282-90-0039).
The efficacy of numerous medications and bed rest during pregnancy is questionable in preventing pre-term delivery.
A study conducted as part of the Patient Outcomes Research Team (PORT) on Low Birth Weight in Minority and High-Risk Women finds many of the treatments purported to inhibit uterine contractions, including bed rest, to be of questionable benefit. The study also finds little scientific evidence to support several interventions intended to improve birth outcomes, such as C-section to reduce intracranial hemorrhage.
Goldenberg RL, Bronstein JM. Preventing low birth weight. In: Wallace HM, Nelson RP, Sweeney PJ, editors. Maternal and child health practices. Oakland, CA: Third Party Publishing Co., 1994. (Contract No. HS-282-92-0055).
Studies in Progress
Evaluating safety and cost effectiveness of out-of-hospital birth centers.
Lack of access to prenatal and obstetrical services for low-income women is thought to lead to poorer birth outcomes and increased neonatal medical costs. Studies of out-of-hospital birth centers suggest they are as safe as, and less expensive than traditional hospital delivery systems. This study will examine whether such centers are acceptable, safe, and cost effective for delivery of prenatal and perinatal services for a primarily Latina underserved population in San Diego, CA. William H. Swartz, Principal Investigator (Grant No. HS-O7161).
Immediate measures of birth outcomes, and the comparative effectiveness of high-risk obstetrical services and practice styles.
This project is developing an outcome measure designed to reflect the immediate condition of the newborn, provide tools for comparison of high-risk obstetrical services, identify effective practice styles, and evaluate resource use. While high-risk births are a small percentage of all births, they account for the majority of maternal, fetal, and neonatal morbidity and mortality. Susan Berman, Principal Investigator (Grant No. HS-O8830).
Use of prenatal care among women from Central and South America.
This project will examine the extent to which financial, personal, and health care system barriers deter access to prenatal care among low- and moderate-income ethnic women in a Latin and Central American community. Paula A. Braveman, Principal Investigator (Grant No. HS-O7910).
Reducing premature and low birth weight among minority women.
Nearly 70 percent of all infant mortality is associated with low birth weight, as is about one-third of all handicapping conditions. Some minority women, especially African-Americans, have substantially higher rates of low birth weight babies than do white women.
This Patient Outcomes Research Team (PORT) on Low Birth Weight in Minority and High-Risk Women will: (1) identify practice variations before and during pregnancy that aim to prevent low birth weight and related sequelae; (2) understand the reasons for variations; (3) determine the clinical and cost effectiveness of different practices; (4) develop clinical, client, and health care system recommendations; and (5) disseminate the findings to promote effective practice. Robert L. Goldenberg, Principal Investigator (Contract No. HS-282-92-0055).
Study of infant death rates among high-risk, Mexican-American teens.
Birth records among teenage Mexican Americans for the years 1935 to 1985 will be examined, to better understand the etiology of low birth weight and infant death in this high-risk population. Kathryn A. Sowards, Principal Investigator (Grant No. HS-O7542).
Reducing post-discharge, high-cost, intensive care and infant mortality among premature and low birth weight infants born to black and Hispanic teenagers.
The aim of this project is to reduce the need for intensive care for premature infants in the first few months after hospital discharge, and to reduce post-discharge infant mortality among low birth weight infants born to low-income families. Participants in the study include black and Hispanic teenagers who live in communities near Dallas, TX. Jon E. Tyson, Principal Investigator (Grant No. HS-O6837).
Assessing the relationship between low-income status and patient satisfaction, and the characteristics of prenatal care received.
The focus of this project is to examine the relationship between global characteristics of prenatal care and the satisfaction with that care for African-American, Mexican-American, and Puerto Rican women on Medicaid. Arden S. Handler, Principal Investigator (Grant No. HS-O8115).
Developing family planning interventions for homeless women.
This study is assessing ways to improve use of health care services and approaches to increasing use of contraceptives, family planning, and gynecological and prenatal health services among homeless women. Existing studies of homeless women living in shelters or visiting clinics indicate that they are unlikely to use birth control, leading to unplanned pregnancies; and, that they receive inadequate gynecological and prenatal care, and have poor birth outcomes. Lillian Gelberg, Principal Investigator (Grant No. HS-O8323).
Costs and Effectiveness of Clinical Preventive Services
Screening for genital chlamydia is cost effective in patients up to age 50.
In this study of 2,400 women in a primary care practice, a cost-utility analysis showed that screening all patients up to age 50 for genital chlamydia is highly cost effective. However, the investigators found that selective screening of high-risk patients with culture is more cost effective than universal screening, and saves money compared to no testing or testing only symptomatic patients.
Four risk factors that are independently associated with chlamydia infection were identified: age (up to 30); African-American race; cervical friability; and multiple sexual partners. Sonnenberg FA, Selker HP, Griffith JL, et al. A clinical decision aid for genital chlamydia in women. Final report, 1995. (Grant No. HS-06396).
Study in Progress
Methods for recruiting women into breast and cervical cancer screening, and effectiveness of these methods among specific racial and ethnic groups.
This project will study the effectiveness of interventions designed to increase appointment scheduling for breast and cervical cancer screening in low-income Mexican-American, African-American, and white women, ages 18-64, and will test the interaction of interventions with/against race and ethnicity. Mari Jibaja-Rusth, Principal Investigator (Grant No. HS-O8581).
The trend away from mental health specialty care and toward general medical provider care for depression reduces costs, but worsens outcomes.
In this study, depression went undetected in half of all depressed patients seen by primary care physicians. The study collected data on the medications, counseling, and limitations in daily functioning for severely depressed patients in alternative systems of care in three urban areas. Results showed that, although depressed patients treated for any reason in the general medical care sector had fewer functional limitations than persons receiving no care, patients treated by psychiatrists fared the best.
Researchers found that the patient outcomes and cost effectiveness of care provided by both generalists and specialists could be further improved by providing more appropriate care. Appropriate care was defined to include increased counseling, use of appropriate antidepressant medications daily, and decreased use of minor tranquilizers.
They concluded that although total treatment costs will rise, the value of treatment provided to depressed patients increases with improved quality of care; and, that such improvements are most cost effective in general medical practices.
Strum R, Wells KB. How can care for depression become more cost effective? JAMA 273(1):51-58, 1995. (Grant No. HS-06802).
Depressed persons can be more limited physically and socially than persons with chronic medical conditions, such as diabetes and arthritis.
This study analyzed outcome data on patients with depression or chronic medical conditions 2 years after their initial visit to a physician. At the time of the initial visit, the range of physical functioning scores for the depressed patients was lower. After 2 years, patients with mild depression had deteriorated further. Patients with major depression had improved considerably, but still tended to be worse off in terms of physical limitations and social functioning than those with chronic medical conditions.
Hays RD, Wells KB, Sherbourne CD, et al. Functioning and well-being outcomes of patients with depression compared with chronic general medical illnesses. Arch Gen Psychiatry 52:11-19, 1995. (Grant No. HS-06802).
Study in Progress
Methods for assessing the health care needs of minority women with HIV/AIDS.
There is little research on the health care needs of minority women with AIDS. This project is developing an assessment tool to help clinicians classify which services are most needed by individual patients, and to show which groups (e.g., family, friends, and neighbors) can best meet these needs. Eugene Litwak, Principal Investigator (Grant No. HS-O7265).
Study in Progress
Effectiveness of team training for primary care providers in the identification and management of domestic violence.
Although studies suggest that 2 to 4 million women are physically battered each year by their husbands, former husbands, or boyfriends, primary care providers have not been trained to identify and manage domestic violence injuries. This study, at Group Health Cooperative of Puget Sound in Washington State, is designed to help primary care providers recognize and treat patient injuries and other medical conditions, such as depression or chronic pain syndromes, that may be the result of domestic violence.
Researchers will assess the effectiveness of a domestic violence identification and management program directed not only to the physician, but to the whole health care team. This team training approach will be compared with results of a program which merely heightens awareness of domestic violence through written materials. The costs for implementing these domestic violence interventions will be monitored and analyzed for use by other health providers in evaluating the financial feasibility of similar programs for their sites. Robert S. Thompson, Principal Investigator (Grant No. HS07568).