National Health Collaborative on Violence and Abuse | Briefing Violence Against Women, Children and...

National Health Collaborative on Violence and Abuse | BriefingViolence Against Women, Children and Families: New Health Policy Responses and Opportunities

Transforming the Health Care Response to Domestic Violence

Brigid McCaw, MD, MPH, MS, FACPMedical Director, Family Violence Prevention Program, Kaiser Permanente

My sister Beth is a new mom

In 1981, I start medical school

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

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

In the US, each year

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

6

Abused women experience a

Abused Women Experience a

Campbell et al, 2002

in gynecological, neurological, and stress-related problems.

50% to 70% increase

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

9Brown et al, 2008

Annual Additional Health Care Costs

For Kaiser Permanente Northern California

$212 Million Every Year

$19.3 Million /100,000 women enrollees (age 18-65)

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 servicesWomen’s Preventive Health Care Services Committee

Universal screening for childbearing-age women recommended

…to include prevention of Intimate Partner Violence as part of routine health care services for women?

Is it possible …

…to include prevention of Intimate Partner Violence as part of routine health care services for women?YESYES

Kaiser Permanente’s Innovative Model

http://www.youtube.com/watch?v=uocoMbCg9N8

The KP Systems-Model Approach

Inquiry and Referral

Supportive Environment

Leadershipand

Oversight

On-siteServices

CommunityLinkages

“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

1022

7106

{

{

Emergency Dept. & Urgent Care

Mental Health

Primary Care

Implementation of IPV Services Underway in Every KP Region

Group Health

Northern California

Northwest

Southern California

Colorado Ohio

Mid-Atlantic

Georgia

Hawaii

Robert Pearl,MD The Permanente Medical Group 2007

“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.”

Looking toward the next decade…

We can transform the health care response to Domestic Violence

Brigid McCaw, MD, MS, MPH, FACPMedical Director

Family Violence Prevention Program

The Permanente Medical Group

Brigid.McCaw@kp.org

510-987-2035

kp.org/domesticviolence

Contact Information

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-Women-and-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

Stories of courage, survival, and hopewww.kp.org/domestic violence

Supportive EnvironmentWorkplace Awareness

Cultural Competence Women’s HealthCulturally Competent Care

INQUIRY AND REFERRAL

IPV Chapter includes: Age (teens, elders) Ethnicity Life experiences Adverse Childhood Experiences (ACE)