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

The Business Case forIntimate Partner Violence

Intervention Programs in the Health Care Setting:

The Business Case forIntimate Partner Violence

Intervention Programs in the Health Care Setting:

AuthorsPat Salber MD, MBA Lisa James MA, Family Violence Prevention FundEditorZita Surprenant MD, MPH, University of Kansas Medical Center

Developed by:

Physicians for a Violence-free Society &

The Family Violence Prevention Fund

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 ChildrenImpact 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 ImpactLifetime Health Impact

• smoking

• alcoholism

• substance abuse

• obesity

• depression

• pulmonary disease

• hepatitis

• heart disease

• diabetes

• suicide

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

Failure To Identify IPVFailure 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 CostlyUnaddressed, 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 EmployersCost 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 PracticeCurrent 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 InterventionCost 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 CostsAnnual Health Care Costs

• 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

Demographics/Target Population: Year I Year II Year III

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 NowReasons 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

andand

http://www.pvs.org http://www.endabuse.org

Developed by:Developed by: