A study by Mass General Brigham researchers indicates that intimate partner violence (IPV) referral rates from orthopedic surgery departments are significantly lower compared to emergency departments, suggesting potential missed opportunities for identification. The research highlights that while routine IPV screening is not standard in orthopedic practices, patient encounters in this specialty could serve as avenues for identifying individuals experiencing IPV.
Referral Disparity Identified
The study, published in JB&JS Open Access, analyzed Domestic Abuse Intervention Programs (DAIP) registry data from Massachusetts General Hospital (MGH) and Brigham and Women’s Hospital (BWH) between 2000 and 2024. Among 11,227 patient referrals to these programs, orthopedic surgery accounted for 0.3%. This compares to 29.3% originating from emergency departments. Other referral sources included behavioral health (18.2%) and obstetrics and gynecology (8.4%). The study notes that IPV screening is not routinely performed within orthopedic practices.
Orthopedic Encounters as Identification Opportunities
Investigators observed that for many patients referred by orthopedic departments, no other specialists had been seen in the six months prior to their disclosure of IPV. This suggests that orthopedic surgical teams were, in these instances, the sole clinical providers with an opportunity to connect these individuals with intervention programs. Additionally, over 50% of these patients presented for elective orthopedic care, indicating that IPV can be identified during routine clinical encounters.
Ophelie Lavoie-Gagne, MD, a resident physician in the Department of Orthopaedic Surgery at Mass General Brigham and lead author, stated that all members of the orthopedic care team contribute to identifying patients experiencing IPV. The study identified that patients often form trusting relationships with nurses, surgical trainees, advanced practice providers, and surgeons. Orthopedic surgeons possess specific strengths for IPV screening, including expertise in injury patterns, the establishment of longitudinal patient relationships, and familiarity with pain management.
Recommendations and Future Directions
The study's authors suggest several strategies to potentially improve IPV identification and referral rates within orthopedic settings. These include:
- Enhancing education on IPV-related injuries for orthopedic care teams.
- Correcting misperceptions regarding IPV prevalence.
- Strengthening connections with domestic violence programs and resources.
The research also proposes that artificial intelligence models could assist in detecting signs of IPV and be incorporated into orthopedic screening protocols. Bharti Khurana, MD, MBA, an emergency radiologist at Mass General Brigham and a co-author, commented on the utility of tools such as the Automated Intimate Partner Violence Risk Support System to support clinicians in making referrals.
Methodology and Authorship
The study involved categorizing IPV referrals by department and provider specialty, followed by a review of electronic health records for patients specifically referred by orthopedics. The research team included Ophelie Lavoie-Gagne, Kelsey Brown, Alexander Kwon, Nishant Suneja, Michael J. Weaver, George S. Dyer, Mitchel B. Harris, and Bharti Khurana, all affiliated with Mass General Brigham. Funding for the study was provided by the National Institute of Biomedical Imaging and Bioengineering (NIBIB), the Office of the Director, NIH, and the National Academy of Medicine Scholars in Diagnostic Excellence. The paper is titled "Missed Opportunities in Orthopaedics for Intimate Partner Violence Identification."