Journal of Family Violence

, Volume 28, Issue 8, pp 833–847 | Cite as

Healthcare Can Change from Within: Sustained Improvement in the Healthcare Response to Intimate Partner Violence

  • Bruce Ambuel
  • L. Kevin Hamberger
  • Clare E. Guse
  • Marlene Melzer-Lange
  • Mary Beth Phelan
  • Amy Kistner


There is a great need to demonstrate sustained improvement in healthcare-based inquiry, intervention, and prevention provided to patients exposed to intimate partner violence (IPV). We evaluated implementation of the Healthcare Can Change from Within model (HCCW) in three primary care clinics and an emergency department within a large healthcare system, using two other primary care clinics for a usual-care comparison on selected variables. Outcome measures included individual-level variables (staff knowledge and attitudes) and system characteristics (clinic policies, procedures, patient education materials, and IPV documentation in patient records). Doctors and nurses reported increased self-efficacy, understanding of referral resources, and understanding of legal issues; IPV knowledge was unchanged. Intervention clinics implemented new policies and procedures, increased patient education, and increased documentation of IPV screening, an improvement which was sustained at 2-year follow-up. Results suggest HCCW is a promising practice for improving the healthcare response to IPV.


Intimate partner violence Domestic violence Intimate partner violence screening and inquiry Systems change Healthcare quality improvement Violence prevention Primary care Emergency medicine 



This project was supported by grants from the Healthier Wisconsin Partnership Program Foundation #2004II-0088, B. Ambuel, P.I., and Centers for Disease Control and Prevention R49/CE001175, L.K. Hamberger, P.I.


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Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  • Bruce Ambuel
    • 1
  • L. Kevin Hamberger
    • 1
  • Clare E. Guse
    • 1
  • Marlene Melzer-Lange
    • 2
  • Mary Beth Phelan
    • 3
  • Amy Kistner
    • 1
  1. 1.Department of Family and Community MedicineMedical College of WisconsinMilwaukeeUSA
  2. 2.Department of PediatricsMedical College of WisconsinMilwaukeeUSA
  3. 3.Department of Emergency MedicineMedical College of WisconsinMilwaukeeUSA

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