Embed Size (px)
Citation preview
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
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)
