Trauma screening in chronic disease management: a quality improvement project

Abstract

More than two decades of research has established the association of adverse childhood experiences (ACEs) and adverse health outcomes in adults as initially proposed in the original study by Felitti and colleagues across multiple, well-designed studies. Research indicates that this is a common problem affecting nearly two out of three in the general population. The positive, dose-related, cumulative association of ACEs and poor health outcomes in chronic diseases including diabetes, heart disease, lung disease, and others has been shown to shorten life expectancy by as much as twenty years compared to those with fewer ACEs. Despite the evidence, screening for ACEs in adult primary care is rare. This scholarly project utilized the Trauma-Informed Care framework to introduce an ACE screening tool in the electronic health record of a rural primary care setting. The target population for screening was adults with specific chronic medical conditions. The primary outcome measure was screening tool utilization, and the secondary measure was the referral to integrated behavioral health (IBH). In a six-week period, ACE screening tool utilization was low, being completed in only 9 of 494 included patient encounters. During the project period, the IBH referral rate increased from 1% to 12% in the same patient sample. Provider and organizational acceptance of the tool were modest. This scholarly project demonstrates several challenges that exist when translating research to practice. More time, education, and resources are needed to close this important research to practice gap.