Authors Pat Salber MD, MBA Lisa James MA, Family Violence Prevention Fund Editor

1. 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

2. Seminar Agenda: • Health Care Impact of IPV • Cost of IPV • Benefits, Components, and Cost of a comprehensive health care response to IPV

3. 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

4. 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

5. Indirect Health Impact of IPV • Increased injurious health behaviors • Reduced preventive health behaviors • Problems managing co-morbid conditions

6. 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

7. 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

8. 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

9. 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

10. 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

11. 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

12. 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

13. 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

14. 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

15. What is a Clinical Response to Abuse? • Routine Screening • Support and Education • Documentation • Safety Assessment • Referral

16. 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

17. Cost of Intervention • Cost includes • member and provider materials • training • site specific interventions • continuous quality improvement (CQI) and evaluation • administrative overhead

18. 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

19. 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

20. 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

21. 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

22. 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

23. Developed by: and http://www.endabuse.org http://www.pvs.org