Transcript Slide 1

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
Zita Surprenant MD, MPH, University of Kansas Medical Center
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
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
• 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
• Increased injurious health behaviors
• Reduced preventive health behaviors
• Problems managing co-morbid
conditions
Impact of IPV on Children
• Injury, trauma,
and child abuse
• Fear
• Depression
• Anxiety
• Suicidal
tendencies
• Sleeplessness
• Psychosomatic
symptoms
• Withdrawal
• Low self-esteem
• Risk for asthma,
colds and flu
• Eating disorders
• Impact on early
brain development
Lifetime Health Impact
Adverse childhood experiences,
including witnessing domestic
violence puts adults at higher risk
for:
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smoking
alcoholism
substance abuse
obesity
depression
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pulmonary disease
hepatitis
heart disease
diabetes
suicide
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
• $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
• 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.
• 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
• 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?
• 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
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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?
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Routine Screening
Support and Education
Documentation
Safety Assessment
Referral
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 includes
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member and provider materials
training
site specific interventions
continuous quality improvement (CQI) and
evaluation
• administrative overhead
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
Demographics/Target Population:
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Patient Population Eligible for Screening
Estimated Patients Seen per Year
Estimated DV Patients in Population
Without Intervention Training 30
With Intervention Training
Annual Health Care Costs
10% - less aggressive program
25% - moderately aggressive program
50% - aggressive program
Estimated Providers/Personnel Trained
Total Physicians
Initial
Reinforcement
Total Licensed HCPs
Initial
Reinforcement
Year I
Year II
Year III
50,000
25,000
50,000
25,000
50,000
25,000
30
750
30
750
750
$32,400
$81,000
$162,000
$32,400
$81,000
$162,000
$32,400
$81,000
$162,000
30
$6,000
$0
70
$5,250
$0
30
$60
$3,000
71
$105
$2,625
31
$60
$3,030
73
$107
$2,678
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
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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
• 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:
and
http://www.pvs.org
http://www.endabuse.org