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The Business Case for Intimate Partner Violence Intervention Programs in the Health Care Setting:. Developed by: Physicians for a Violence-free Society & The Family Violence Prevention Fund. Authors Pat Salber MD, MBA Lisa James MA, Family Violence Prevention Fund Editor

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the business case for intimate partner violence intervention programs in the health care setting
The Business Case forIntimate Partner ViolenceIntervention Programs in the Health Care Setting:

Developed by:

Physicians for a Violence-free Society &

The Family Violence Prevention Fund

Authors

Pat Salber MD, MBA

Lisa James MA, Family Violence Prevention Fund

Editor

Zita Surprenant MD, MPH, University of Kansas Medical Center

seminar agenda
Seminar Agenda:
  • Health Care Impact of IPV
  • Cost of IPV
  • Benefits, Components, and Cost of a comprehensive health care response to IPV
prevalence of intimate partner violence
Prevalence of Intimate Partner Violence

Family Violence is Very Common:

  • 3.9 million women physically abused annually
  • 31% report lifetime prevalence
  • 1,642 murders by intimates in 1999
  • More prevalent among women than diabetes, breast cancer, and cervical cancer
direct health impact on adult and teen victims
Direct Health Impact on Adult and Teen Victims
  • Acute Trauma and Death
  • Chronic pain
  • Headaches
  • Fatigue
  • Depression
  • Anxiety
  • Suicidal ideation/attempt
  • STD
  • Pregnancy complications
  • Alcohol/ substance abuse
  • Chronic abdominal pain
  • Central nervous and cardiac symptoms
indirect health impact of ipv
Indirect Health Impact of IPV
  • Increased injurious health behaviors
  • Reduced preventive health behaviors
  • Problems managing co-morbid conditions
impact of ipv on children
Impact of IPV on Children
  • Psychosomatic
  • symptoms
  • Withdrawal
  • Low self-esteem
  • Risk for asthma,
  • colds and flu
  • Eating disorders
  • Impact on early
  • brain development
  • Injury, trauma, and child abuse
  • Fear
  • Depression
  • Anxiety
  • Suicidal tendencies
  • Sleeplessness
lifetime health impact
pulmonary disease

hepatitis

heart disease

diabetes

suicide

Lifetime Health Impact

Adverse childhood experiences, including witnessing domestic violence puts adults at higher risk for:

  • smoking
  • alcoholism
  • substance abuse
  • obesity
  • depression
failure to identify ipv
Failure To Identify IPV
  • Results in:
    • incorrect diagnosis
    • costly and inappropriate tests
    • ongoing morbidity and mortality
  • Impact is progressive and repetitive
    • multiple health care contacts
unaddressed ipv is costly
Unaddressed, IPV is Costly
  • $1,775 more per year spent on victims
  • Victims have 1.5-2.3 times higher costs

(equivalent to $1,722 to $2,790 annually)

  • Research from in-patient settings found victims cost $850 more per stay
  • Increased utilization and hospitalizations
    • more hospitalizations: 77% vs. 50% controls
    • 420 admissions vs. 199 admissions
cost to employers
Cost to Employers
  • Hidden cost
    • abuse related absenteeism
      • 54% missed an average of 3 days more per month
    • decreased productivity
      • 37% report job performance impacted
cost to employers cont
Cost to Employers, cont.
  • Workplace security concerns
  • In a survey of EAP programs:
    • 83% said they had employees with restraining orders
    • 71% of programs had an employee stalked before
  • Employers may be liable for inadequate response to IPV in the workplace
current practice
Current Practice
  • Less than 10% of providers routinely screen for IPV
  • Less than 10% managed care plans have comprehensive systems for IPV
  • Only 28% have screening policies/guidelines
why respond to ipv
Why Respond to IPV?
  • Experts recommend it
  • Research demonstrates that it is effective
  • Some states and oversight agencies require it
  • Becoming a standard of care
patients providers and purchasers support dv programs
Patients, Providers, and Purchasers Support DV Programs
  • Patients support screening
  • Increased member satisfaction
  • Providers satisfied with DV programs
  • Purchasers include DV programs as a component of quality care
what is a clinical response to abuse
What is a Clinical Response to Abuse?
  • Routine Screening
  • Support and Education
  • Documentation
  • Safety Assessment
  • Referral
beyond screening system based response to ipv
Beyond Screening: System Based Response to IPV
  • Staff training
  • Protocol development and dissemination
  • Creating a supportive environment
  • On site domestic violence services
  • Linking to community resources
cost of intervention
Cost of Intervention
  • Cost includes
    • member and provider materials
    • training
    • site specific interventions
    • continuous quality improvement (CQI) and evaluation
    • administrative overhead
return on investment roi for dv programs
Return on Investment (ROI) for DV Programs
  • Excel spreadsheet that can be used to calculate estimate ROI
  • Examines potential costs avoided
    • For annual health care costs per patient
  • Measured against cost of intervention
annual health care costs
Annual Health Care Costs

Demographics/Target Population: Year I Year II Year III

  • Patient Population Eligible for Screening 50,000 50,000 50,000
  • Estimated Patients Seen per Year 25,000 25,000 25,000
  • Estimated DV Patients in Population
  • Without Intervention Training 30 30 30
  • With Intervention Training 750 750 750
  • Annual Health Care Costs
  • 10% - less aggressive program $32,400 $32,400 $32,400
  • 25% - moderately aggressive program $81,000 $81,000 $81,000
  • 50% - aggressive program $162,000 $162,000 $162,000
  • Estimated Providers/Personnel Trained
  • Total Physicians 30 30 31
  • Initial $6,000 $60 $60
  • Reinforcement $0 $3,000 $3,030
  • Total Licensed HCPs 70 71 73
  • Initial $5,250 $105 $107
  • Reinforcement $0 $2,625 $2,678
health care domestic violence programs questions and concerns
Health Care Domestic Violence Programs: Questions and Concerns
  • Limited research on improved health outcomes or potential cost savings
  • Partial implementation is ineffective
  • Results of the program take time
benefits of a domestic violence program
Benefits of a Domestic Violence Program
  • Improved identification and quality of care
  • Compliance with regulatory standards
  • Increased patient and purchaser satisfaction
  • Will likely decrease:
    • hospitalizations and high cost specialty care
    • misdiagnosis and unnecessary work-ups
    • workplace costs and liability
  • Will likely improve care for chronic health problems
reasons for action now
Reasons for Action Now
  • Interventions have proven effective
  • DV programs are cost-effective
    • interventions are affordable
    • emerging research expects to demonstrate a 20% decrease in health care costs as a result of hospital-based dv interventions.
  • Successful models and materials exist
  • It’s the right thing to do
developed by
Developed by:

and

http://www.endabuse.org

http://www.pvs.org