Briefly describe a specific question, or set of related questions, about a health care test or treatment that this program should consider.

For victims of intimate partner violence (including controlling behaviors), are infant and maternal outcomes better with screening and and referral for services during and after pregnancy, or better to not ask?

Does your question include a comparison of different health care approaches? (If no, your topic will still be considered.)

yes

If yes, explain the specific technologies, devices, drugs, or interventions you would like to see compared:

Screening and referral versus none, compare outcomes in terms of infant and maternal pregnancy associated mortality

What patients or group(s) of patients does your question apply to? (Please include specific details such as age range, gender, coexisting diagnoses, and indications for therapy.)

Women of reproductive age, seeking care for a pregnancy related condition or seeking infant care for their infant.

Are there subgroups of patients that your question might apply to? (For example, an ethnic group, stage or severity of a disease.)

All, but biggest difference in outcomes will be seen in women at highest risk for prematurity, infant, and maternal (pregnancy associated) mortality.

Describe the health-related benefits you are interested in. (For example, improvements in patient symptoms or problems from treatment or diagnosis.)

Benefits: reduction in prematurity, reduction in infant mortality, reduction in maternal pregnancy associated mortality.

Describe any health-related risks, side effects, or harms that you are concerned about.

Risk to woman of being screened, and being encouraged to leave a unhealthy relationship may actually increase her risk of harm by the abuser/batterer.

Appropriateness for EHC Program

Does your question include a health care drug, intervention, device, or technology available (or likely to be available) in the U.S.?

no

Which priority area(s) and population(s) does this topic apply to? (check all that apply)

EHC Priority Conditions (updated in 2008)

• Pregnancy, including preterm birth

AHRQ Priority Populations

• Low income groups
• Minority groups
• Women
• Children

Federal Health Care Program

• Medicaid
• State Children's Health Insurance Program (SCHIP)

Importance

Describe why this topic is important.

Our nation has higher prematurity, infant mortality and maternal pregnancy associated mortality than other OECD nations.

We have this odd "episode of care" payment system for women of low income. Their health benefits run out after their post partum checkup, when they need the most care for family planning and for their own chronic health conditions such as diabetes, high blood pressure, mental illness, substance abuse.

What specifically motivated you to ask this question? (For example, you are developing a clinical guideline, working with a policy with large uncertainty about the appropriate approach, costly intervention, new research you have read, items in the media you may have seen, a clinical practice dilemma you know of, etc.)

Would like to see screening and referral included in the new quality guidelines for insurance exchanges and medicaid, if there is evidence it is more helpful than harmful.

Although screening is considered standard of care, it is not uniformly done due to provider misgivings about the effects.

Does your question represent uncertainty for clinicians and/or policy-makers? (For example, variations in clinical care, controversy in what constitutes appropriate clinical care, or a policy decision.)

yes

If yes, please explain:

As above. Even caring providers have doubts as to whether it is worthwhile to screen

Potential Impact

How will an answer to your research question be used or help inform decisions for you or your group?

Will help family medicine, ob-gyn, and pediatrics deal with this vulnerable population with demonstrated health disparities by race and income.

Describe the timeframe in which an answer to your question is needed.

By 2014 when Medicaid rolls expand rapidly.

Describe any health disparities, inequities, or impact on vulnerable populations your question applies to.

Prematurity, infant mortality, maternal mortality are all increased in populations suffering other health disparities.

Nominator Information

Other Information About You: (optional)

Please choose a description that best describes your role or perspective: (you may select more than one category if appropriate)

Will help family medicine, ob-gyn, and pediatrics deal with this vulnerable population with demonstrated health disparities by race and income.

Are you making a suggestion as an individual or on behalf of an organization?

Individual

Please tell us how you heard about the Effective Health Care Program

Trolling the internet