Transcript Document

Transforming the Health Care
Response to Domestic Violence
Brigid McCaw, MD, MPH, MS, FACP
Medical Director, Family Violence Prevention Program,
Kaiser Permanente
National Health Collaborative on Violence and Abuse | Briefing
Violence Against Women, Children and Families: New Health Policy
Responses and Opportunities
In 1981, I start
medical school
My sister Beth
is a new mom
We were both trying to learn how to save lives…
Why is IPV important in health care?
IPV is extremely common
The health effects are
devastating
The health care costs are
substantial
IPV impacts future generations
Health care interventions
make a difference
Comparison to Other Life-Threatening
Conditions Affecting Women
In the US, each year
New cases of breast cancer[2]
211,000
Number of women dying from
cardiovascular disease[3]
484,000
Women who are injured from IPV[4]
2,000,000
Health Effects of IPV:
Injuries & Death
• Most common cause of injury
in women aged 18-44
• A leading cause of pregnancy
associated mortality
• Rape
• Homicide
• Suicide
Abused women experience a
Abused Women Experience a
50% to 70%
increase
in gynecological, neurological,
and stress-related problems.
6
Campbell et al, 2002
Higher Utilization of
Health Care Services
• 14 - 21% higher for primary care and
specialty care
• 50% higher for emergency department
• 2 times higher for mental health
• 6 times higher for chemical dependency
services
Source: Group Health Cooperative, Seattle
IPV and Chronic Health Problems
• 60% more likely
to have asthma
• 70% more likely
to have heart disease
• 80% more likely to have a stroke
• 2x as likely to be a current smoker
Source: Centers for Disease Control (CDC) February 2008
US medical costs for IPV in the
year after victimization
$4 to $7 Billion
Brown et al, 2008
9
Annual Additional Health Care Costs
For$19.3
KaiserMillion
Permanente
/100,000Northern
women California
enrollees (age 18-65)
$212 Million Every Year
For Kaiser Permanente
$580 Million Every Year
Another Cost: Impact on Children of
Witnessing IPV
Intervention Makes a Difference!
Women who talked to their health care provider about the abuse
were nearly 4 times more likely to use an intervention
Healing and Recovery Happens
• The majority of women eventually end their
relationship with violent partners (On average,
after 3-5 attempts and about 7 years)
• The majority of women do not have recurrent
abusive relationships
• Health care costs go down after abuse
ends
IPV screening and counseling should be
core part of women’s health services
Women’s Preventive Health Care Services Committee
Universal screening for childbearing-age
women recommended
Is it possible …
…to include prevention
of Intimate Partner
Violence as part of
routine health care
services for women?
Kaiser Permanente’s Innovative Model
http://www.youtube.com/watch?v=uocoMbCg9N8
The KP Systems-Model Approach
Inquiry and
Referral
On-site
Services
Leadership
and
Oversight
Supportive
Community
Environment
Linkages
“Making the right thing easier to do”
Using Technology to Improve Care
• Engaging patients:
– Online information for patients
– Secure messaging
– Call Centers
• Supporting clinicians:
– Tools in electronic medical record
– Online clinician training
– Point-of-care online resources
New Online Resource on Health and IPV
 Supported by DHHS Family
Violence Prevention and Services
Program
 Offers patient and provider
educational tools and resources
www.healthcaresaboutipv.org
KP Northern California: Seven-fold
Increase in IPV Identification
Members Diagnosed with Intimate Partner Violence, 2000-2011
7106
4,500
{
4,000
3,500
Emergency Dept. & Urgent Care
Mental Health
Primary Care
3,000
2,500
2,000
1,500
1,000
1022
{
500
0
Year
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012
Implementation of IPV Services
Underway in Every KP Region
Group Health
Northwest
Northern California
Colorado
Ohio
Mid-Atlantic
Southern California
Georgia
Hawaii
“Domestic violence prevention is part of a
strategic approach to both quality and
affordability. By doing the right thing, we can
improve quality, increase service and
satisfaction, while also decreasing costs to
employers and patients.”
Robert Pearl,MD
The Permanente Medical Group 2007
Looking toward the next decade…
We can transform
the health care response to
Domestic Violence
Contact Information
Brigid McCaw, MD, MS, MPH, FACP
Medical Director
Family Violence Prevention Program
The Permanente Medical Group
[email protected]
510-987-2035
kp.org/domesticviolence
Resources
 "Using a Systems-Model Model approach to Improving IPV
Services in a Large Health Care Organization". Institute of
Medicine. 2011
http://www.iom.edu/Reports/2011/Preventing-Violence-Against-Womenand-Children-Workshop-Summary.aspx
 AHRQ Tool for Assessment of Health System Response
http://www.ahrq.gov/research/domesticviol
 AHRQ Innovations Solution: “Family Violence Prevention
Program significantly improves ability to identify and facilitate
treatment for patients affected by domestic violence,”
http://www.innovations.ahrq.gov/content.aspx?id=2343
 Health Resource Center on Domestic Violence, Futures
Without Violence
http://www.futureswithoutviolence.org/content/features/detail/790/
 Kaiser Permanente Domestic Violence website
kp.org/domesticviolence
END
Supportive Environment
Workplace Awareness
Stories of courage, survival, and hope
www.kp.org/domestic violence
INQUIRY AND REFERRAL
Women’s
Health
Cultural Competence
Culturally Competent Care
IPV Chapter includes:
 Age (teens, elders)
 Ethnicity
 Life experiences
 Adverse Childhood
Experiences (ACE)