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Appleby J, Georghiou T, Ledger J, Rolewicz L, Sherlaw-Johnson C, Tomini SM, Frerich JM, Ng PL. Youth violence intervention programme for vulnerable young people attending emergency departments in London: a rapid evaluation. HEALTH AND SOCIAL CARE DELIVERY RESEARCH 2023; 11:1-122. [PMID: 37470144 DOI: 10.3310/jwkt0492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/21/2023]
Abstract
Background Youth violence intervention programmes involving the embedding of youth workers in NHS emergency departments to help young people (broadly aged between 11 and 24 years) improve the quality of their lives following their attendance at an emergency department as a result of violent assault or associated trauma are increasing across the NHS. This study evaluates one such initiative run by the charity Redthread in partnership with a NHS trust. Objectives To evaluate the implementation and impact of a new youth violence intervention programme at University College London Hospital NHS Trust and delivered by the charity Redthread: (1) literature review of studies of hospital-based violent crime interventions; (2) evaluation of local implementation and of University College London Hospital staff and relevant local stakeholders concerning the intervention and its impact; (3) assessment of the feasibility of using routine secondary care data to evaluate the impact of the Redthread intervention; and (4) cost-effectiveness analysis of the Redthread intervention from the perspective of the NHS. Methods The evaluation was designed as a mixed-methods multiphased study, including an in-depth process evaluation case study and quantitative and economic analyses. The project was undertaken in different stages over two years, starting with desk-based research and an exploratory phase suitable for remote working while COVID-19 was affecting NHS services. A total of 22 semistructured interviews were conducted with staff at Redthread and University College London Hospital and others (e.g. a senior stakeholder involved in NHS youth violence prevention policy). We analysed Redthread documents, engaged with experts and conducted observations of staff meetings to gather more in-depth insights about the effectiveness of the intervention, the processes of implementation, staff perceptions and cost. We also undertook quantitative analyses to ascertain suitable measures of impact to inform stakeholders and future evaluations. Results Redthread's service was viewed as a necessary intervention, which complemented clinical and other statutory services. It was well embedded in the paediatric emergency department and adolescent services but less so in the adult emergency department. The diverse reasons for individual referrals, the various routes by which young people were identified, and the mix of specific support interventions provided, together emphasised the complexity of this intervention, with consequent challenges in implementation and evaluation. Given the relative unit costs of Redthread and University College London Hospital's inpatient services, it is estimated that the service would break even if around one-third of Redthread interventions resulted in at least one avoided emergency inpatient admission. This evaluation was unable to determine a feasible approach to measuring the quantitative impact of Redthread's youth violence intervention programme but has reflected on data describing the service, including costs, and make recommendations to support future evaluation. Limitations The COVID-19 pandemic severely hampered the implementation of the Redthread service and the ability to evaluate it. The strongest options for analysis of effects and costs were not possible due to constraints of the consent process, problems in linking Redthread and University College London Hospital patient data and the relatively small numbers of young people having been engaged for longer-term support over the evaluation period. Conclusions We have been able to contribute to the qualitative evidence on the implementation of the youth violence intervention programme at University College London Hospital, showing, for example, that NHS staff viewed the service as an important and needed intervention. In the light of problems with routine patient data systems and linkages, we have also been able to reflect on data describing the service, including costs, and made recommendations to support future evaluation. Future work No future work is planned. Funding National Institute for Health and Care Research Health Services and Delivery Research programme (RSET: 16/138/17).
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Affiliation(s)
| | | | - Jean Ledger
- Department of Applied Health Research, University College London, London, UK
| | | | | | - Sonila M Tomini
- Department of Applied Health Research, University College London, London, UK
| | - Jason M Frerich
- T.H. Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Pei Li Ng
- Department of Applied Health Research, University College London, London, UK
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Portnoy J, Schwartz JA. Adolescent Violent Delinquency Associated With Increased Emergency Department Usage in Young Adulthood. INTERNATIONAL JOURNAL OF OFFENDER THERAPY AND COMPARATIVE CRIMINOLOGY 2023; 67:739-756. [PMID: 34963357 DOI: 10.1177/0306624x211066835] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Limited research has examined the extent to which adolescent delinquency predicts healthcare usage in young adulthood, including emergency department (ED) visits. This study used data from 3,310 adolescents (52.05% female; mean age at Wave I = 16.04 years) from the sibling subsample of the National Longitudinal Study of Adolescent to Adult Health (Add Health). We examined whether adolescent delinquency at Wave I predicted ED visits at Wave III using sibling fixed effects models to adjust estimates for within-family unobserved heterogeneity. Increased violent, but not nonviolent, delinquency predicted a higher number of ED visits in early adulthood in the sibling fixed effects models. To our knowledge, this is the first study to examine the relationship between delinquency and ED usage using a sibling fixed effects design. Findings demonstrate that violent adolescent delinquency may increase healthcare usage and suggest the potential role of healthcare providers in improving outcomes for delinquent youth.
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Affiliation(s)
- Jill Portnoy
- University of Massachusetts Lowell, Lowell, MA, USA
| | - Joseph A Schwartz
- Florida State University, Tallahassee, FL, USA
- King Abdulaziz University, Jeddah, Saudi Arabia
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Mueller KL, Chapman-Kramer K, Cooper BP, Kaser T, Mancini M, Moran V, Vogel M, Foraker RE, Anwuri V. A Regional Approach to Hospital-Based Violence Intervention Programs Through LOV. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2023; 29:306-316. [PMID: 36961541 DOI: 10.1097/phh.0000000000001716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/25/2023]
Abstract
CONTEXT Community violence is an underaddressed public health threat. Hospital-based violence intervention programs (HVIPs) have been used to address the root causes of violence and prevent reinjury. OBJECTIVE In this article, we describe the methodology of the St Louis Region-wide HVIP, Life Outside Violence (LOV) program, and provide preliminary process outcomes. DESIGN Life Outside Violence mentors intervene following a violent injury to decrease risk of subsequent victimization and achieve goals unique to each participant by providing therapeutic counseling and case management services to patients and their families. PARTICIPANTS AND SETTING Eligible patients are victims of violent injury between the ages of 8 and 24 years, who are residents of St Louis, Missouri, and present for care at a LOV partner adult or pediatric level I trauma hospital. INTERVENTION Enrolled participants receive program services for 6 to 12 months and complete an individual treatment plan. MAIN OUTCOME MEASURES In this article, we report LOV operational methodology, as well as process metrics, including program enrollment, graduation, and qualitative data on program implementation. RESULTS From August 15, 2018, through April 30, 2022, 1750 LOV-eligible violently injured patients presented to a partner hospital, 349 were approached for program enrollment, and 206 consented to enroll in the program. During this pilot phase, 91 participants graduated from the LOV program and have process output data available for analysis. CONCLUSIONS Life Outside Violence has been implemented into clinical practice as the first HVIP to influence across an entire region through partnership with multiple university and hospital systems. It is our hope that methods shared in this article will serve as a primer for organizations hoping to implement and expand HVIPs to interrupt community violence at the regional level.
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Affiliation(s)
- Kristen L Mueller
- Department of Emergency Medicine, Washington University in St Louis School of Medicine, St Louis, Missouri (Dr Mueller); Institute for Public Health, Washington University in St Louis School of Medicine, St Louis, Missouri (Mss Chapman-Kramer, Kaser, and Anwuri, Mr Cooper, and Dr Foraker); Saint Louis University School of Social Work, St Louis, Missouri (Dr Mancini); Trudy Busch Valentine School of Nursing, Saint Louis University, St Louis, Missouri (Dr Moran); and School of Criminal Justice, University at Albany, Albany, New York (Dr Vogel)
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Timmer-Murillo SC, Schroeder ME, Trevino C, Geier TJ, Schramm AT, Brandolino AM, Hargarten S, Holena D, de Moya M, Milia D, deRoon-Cassini TA. Comprehensive Framework of Firearm Violence Survivor Care: A Review. JAMA Surg 2023; 158:541-547. [PMID: 36947025 DOI: 10.1001/jamasurg.2022.8149] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2023]
Abstract
Importance Firearm violence is a public health crisis placing significant burden on individuals, communities, and health care systems. After firearm injury, there is increased risk of poor health, disability, and psychopathology. The newest 2022 guidelines from the American College of Surgeons Committee on Trauma require that all trauma centers screen for risk of psychopathology and provide referral to intervention. Yet, implementing these guidelines in ways that are responsive to the unique needs of communities and specific patient populations, such as after firearm violence, is challenging. Observations The current review highlights important considerations and presents a model for trauma centers to provide comprehensive care to survivors of firearm injury. This model highlights the need to enhance standard practice to provide patient-centered, trauma-informed care, as well as integrate inpatient and outpatient psychological services to address psychosocial needs. Further, incorporation of violence prevention programming better addresses firearm injury as a public health concern. Conclusions and Relevance Using research to guide a framework for trauma centers in comprehensive care after firearm violence, we can prevent complications to physical and psychological recovery for this population. Health systems must acknowledge the socioecological context of firearm violence and provide more comprehensive care in the hospital and after discharge, to improve long-term recovery and serve as a means of tertiary prevention of firearm violence.
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Affiliation(s)
| | - Mary E Schroeder
- Division of Trauma and Acute Care Surgery, Medical College of Wisconsin, Milwaukee
| | - Colleen Trevino
- Division of Trauma and Acute Care Surgery, Medical College of Wisconsin, Milwaukee
| | - Timothy J Geier
- Division of Trauma and Acute Care Surgery, Medical College of Wisconsin, Milwaukee
| | - Andrew T Schramm
- Division of Trauma and Acute Care Surgery, Medical College of Wisconsin, Milwaukee
| | - Amber M Brandolino
- Division of Trauma and Acute Care Surgery, Medical College of Wisconsin, Milwaukee
| | - Stephen Hargarten
- Division of Emergency Medicine, Medical College of Wisconsin, Milwaukee
| | - Daniel Holena
- Division of Trauma and Acute Care Surgery, Medical College of Wisconsin, Milwaukee
| | - Marc de Moya
- Division of Trauma and Acute Care Surgery, Medical College of Wisconsin, Milwaukee
| | - David Milia
- Division of Trauma and Acute Care Surgery, Medical College of Wisconsin, Milwaukee
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Gallen KM, Smith MJ, Crane J, Loughran C, Schuster K, Sonnenberg J, Reese M, Girard VW, Song JS, Hall EC. Law Enforcement and Patient Privacy Among Survivors of Violence: A Nationwide Mixed-Methods Study. J Surg Res 2023; 283:648-657. [PMID: 36455418 DOI: 10.1016/j.jss.2022.11.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 10/31/2022] [Accepted: 11/06/2022] [Indexed: 11/29/2022]
Abstract
INTRODUCTION During the emergent treatment of violently injured patients, law enforcement (LE) officers and health care providers frequently interact. Both have duties to protect patient health, rights, and public health, however, the balance of these duties may feel at odds. The purpose of this study is to assess hospital-based violence intervention program (HVIP) representatives' experiences with LE officers among survivors of violence and the impact of hospital policies on interactions with LE officers. MATERIALS AND METHODS A nationwide survey was distributed to the 35 HVIPs that form the Health Alliance for Violence Intervention. Data regarding respondent affiliation, programs, and perceptions of hospital policies outlining LE activity were collected. Follow-up video interviews were open coded and qualitatively analyzed using grounded theory. RESULTS Respondents from 32 HVIPs completed the survey (91%), and 22 interviews (63%) were conducted. Common themes from interviews were: police-patient interactions; racism, bias, and victims' treatment as suspects; and training and education. Only 39% of respondents knew that policies existed and were familiar with them. Most representatives believed their hospitals' existing policies were inadequate, ineffective, or biased. Programs that reported good working relationships with LE officers offered insight on how their programs maintain these partnerships and work with LE officers towards a common goal. CONCLUSIONS Unclear or inadequate policies relating to LE activity may jeopardize the health and privacy of violently injured patients. Primary areas identified for improvement include clarifying and revising hospital policies, education of staff and LE officers, and improved communication between health care providers and LE officers to better protect patient rights.
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Affiliation(s)
- Kate M Gallen
- Department of Surgery, Georgetown University School of Medicine, Washington, District of Columbia
| | - Michael J Smith
- Georgetown University Law Center, Washington, District of Columbia
| | - Joshua Crane
- Department of Surgery, Georgetown University School of Medicine, Washington, District of Columbia
| | - Carly Loughran
- Georgetown University Law Center, Washington, District of Columbia
| | - Kirsten Schuster
- Department of Surgery, Georgetown University School of Medicine, Washington, District of Columbia
| | - Jake Sonnenberg
- University of California San Francisco School of Medicine, San Francisco, California
| | - Mildred Reese
- Community Violence Intervention Program, MedStar Washington Hospital Center, Washington, District of Columbia
| | - Vicki W Girard
- Georgetown University Law Center, Washington, District of Columbia
| | - Ji Seon Song
- University of California, Irvine School of Law, Irvine, California
| | - Erin C Hall
- Department of Surgery, Georgetown University School of Medicine, Washington, District of Columbia; Community Violence Intervention Program, MedStar Washington Hospital Center, Washington, District of Columbia.
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Shayan M, Lew D, Mancini M, Foraker RE, Doering M, Mueller KL. A systematic review of recurrent firearm injury rates in the United States. Prev Med 2023; 168:107443. [PMID: 36740145 DOI: 10.1016/j.ypmed.2023.107443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 01/08/2023] [Accepted: 01/31/2023] [Indexed: 02/05/2023]
Abstract
OBJECTIVES To conduct a systematic review of methodologies, data sources, and best practices for identifying, calculating, and reporting recurrent firearm injury rates in the United States. METHODS In accordance with PRISMA guidelines, we searched seven electronic databases on December 16, 2021, for peer-reviewed articles that calculated recurrent firearm injury in generalizable populations. Two reviewers independently assessed the risk of bias, screened the studies, extracted data, and a third resolved conflicts. FINDINGS Of the 918 unique articles identified, 14 met our inclusion criteria and reported recurrent firearm injury rates from 1% to 9.5%. We observed heterogeneity in study methodologies, including data sources utilized, identification of subsequent injury, follow-up times, and the types of firearm injuries studied. Data sources ranged from single-site hospital medical records to comprehensive statewide records comprising medical, law enforcement, and social security death index data. Some studies applied machine learning to electronic health records to differentiate subsequent new firearm injuries from the index injury, while others classified all repeat firearm-related hospital admissions after variably defined cut-off times as a new injury. Some studies required a minimum follow-up observation period after the index injury while others did not. Four studies conducted survival analyses, albeit using different methodologies. CONCLUSIONS Variability in both the data sources and methods used to evaluate and report recurrent firearm injury limits individual study generalizability of individual and societal factors that influence recurrent firearm injury. Our systematic review highlights the need for development, dissemination, and implementation of standard practices for calculating and reporting recurrent firearm injury.
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Affiliation(s)
- Muhammad Shayan
- Cordell Institute for Policy in Medicine & Law, Washington University in St. Louis, United States.
| | - Daphne Lew
- Division of Biostatistics, Washington University in St. Louis, United States.
| | - Michael Mancini
- College for Public Health and Social Justice, Saint Louis University, United States.
| | - Randi E Foraker
- Division of General Medical Sciences, School of Medicine, Washington University in St. Louis, United States.
| | - Michelle Doering
- Bernard Becker Medical Library, Washington University in St. Louis, United States
| | - Kristen L Mueller
- Department of Emergency Medicine, School of Medicine, Washington University in St. Louis, United States.
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Romo ND, Castillo C, Green J, Lin J, Mendelsohn E, Dawkins-Hamilton C, Reddy SH, Blumberg SM. Improving Adolescent Violent Trauma Outcomes With a Hospital-Based Violence Prevention Initiative. Hosp Pediatr 2023; 13:153-158. [PMID: 36597702 DOI: 10.1542/hpeds.2021-006428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND Violent trauma results in significant morbidity/mortality in Black/Hispanic males aged 15 to 24 years. Hospital- and community-level interventions may improve patient and community outcomes. OBJECTIVE To determine if a hospital-based violence prevention intervention using community outreach workers was associated with improved violent trauma patient postdischarge follow-up and reinjury rates. METHODS This is a retrospective, single-center, cohort study of admitted violent trauma patients to a public hospital in the Bronx, NY. Data were collected from a convenience sample of patients aged 15 to 24 years admitted with International Classification of Diseases, 10th Revision, codes for gunshot wound, stab wound, or physical assault from August 2014 to April 2018. The exposure variable was documentation of intervention team evaluation during admission. The outcome variables included attending >50% scheduled postdischarge follow-up visits, and subsequent violent reinjury (gunshot wound, stab wound, blunt assault) during the study time period. Multivariable regression models were used to determine the association between the exposure and outcome variables. RESULTS A total of 535 patients were evaluated and were primarily male (92.5%), Black (54%)/Latino (36.4%), with mean age of 19.1 years. Patients in the exposure group had increased odds of attending >50% of scheduled clinic postdischarge follow-up visits (odds ratio, 2.29; 95% confidence interval 1.59-3.29) and decreased odds of subsequent violent reinjury presentation (odds ratio, 0.41; 95% confidence interval 0.22-0.75) 3 months after hospital discharge. CONCLUSION A hospital-based violence prevention intervention may be associated with decreased odds of violent reinjury and increased odds of postdischarge scheduled appointment adherence in admitted pediatric violent trauma patients.
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Affiliation(s)
- Noé D Romo
- Departments of Pediatrics.,Departments of Pediatrics
| | | | - Jaylen Green
- Departments of Pediatrics.,Departments of Pediatrics
| | - Juan Lin
- Biostatistics, The Albert Einstein College of Medicine, Bronx, New York
| | - Erika Mendelsohn
- Social Work, NYC Health + Hospitals/Jacobi, Bronx, New York.,New York State Department of Criminal Justice Services, SNUG Anti-Violence Initiative, Albany, New York
| | - Carjah Dawkins-Hamilton
- Social Work, NYC Health + Hospitals/Jacobi, Bronx, New York.,New York State Department of Criminal Justice Services, SNUG Anti-Violence Initiative, Albany, New York
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Jensen AD, Taneja K, Ahmad MT, Woreta FA, Rajaii F. Incidence and Characteristics of Orbital Hemorrhages in the United States from 2006 to 2018. Clin Ophthalmol 2022; 16:3369-3380. [PMID: 36237493 PMCID: PMC9553320 DOI: 10.2147/opth.s376447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Accepted: 09/28/2022] [Indexed: 11/22/2022] Open
Abstract
Purpose To determine the incidence, characteristics, and costs associated with orbital hemorrhages presenting to US EDs. Patients and Methods This was a retrospective, longitudinal study of the Nationwide Emergency Department Sample, 2006 to 2018. Medical records from patients presenting to participating hospital-owned EDs and diagnosed with primary or secondary orbital hemorrhage were examined to determine incidence, demographics, clinical characteristics, mechanism, disposition and related risk factors, and costs. Results From 2006 to 2018, an estimated 20,762 US ED visits included an orbital hemorrhage diagnosis. Most primary diagnosis patients were elderly (35%) and male (51%), and incidence increased from 1.1 (95% CI: 0.8-1.4) to 3.1 per million (95% CI: 2.5-3.7, p < 0.0001). Fall was the most common mechanism (21.6%), particularly among the elderly (39.9%). Fall-related diagnoses increased from 0.03 (95% CI: -0.01-0.07) to 1.0 per million (95% CI: 0.7-1.3, p < 0.0001), while overall falls increased by only 7%. Assault-related orbital hemorrhage increased from 0.1 (95% CI: 0.0-0.2) to 0.6 per million (95% CI: 0.4-0.7, p < 0.0001), while overall assaults decreased by 22%. Annual total ED costs increased from $463,220 (95% CI: 233,993-692,446) to $6,117,320 (95% CI: 4,665,403-7,569,237, p < 0.001). Inpatient admission was uncommon (9.0%), but related costs totaled $18.9 million (95% CI: 13.3-24.5). Odds of admission were lower in fall- and objects-related injuries and higher with certain concurrent injuries. Conclusion Orbital hemorrhages are becoming more frequent and costly. A disproportionately large increase in fall- and assault-related diagnoses highlights the need for targeted injury prevention strategies to reduce cost and morbidity.
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Affiliation(s)
- Adrianna D Jensen
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Kamil Taneja
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA,Renaissance School of Medicine, Stony Brook University, Stony Brook, NY, USA
| | - Meleha T Ahmad
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA,Department of Ophthalmology, University of California San Francisco, San Francisco, CA, USA
| | - Fasika A Woreta
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Fatemeh Rajaii
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA,Correspondence: Fatemeh Rajaii, Wilmer Eye Institute, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Maumenee 505, Baltimore, MD, 21287, USA, Tel +1-410-955-1112, Fax +1-410-614-9987, Email
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Schnippel K, Burd-Sharps S, Miller TR, Lawrence BA, Swedler DI. Nonfatal Firearm Injuries by Intent in the United States: 2016-2018 Hospital Discharge Records from the Healthcare Cost and Utilization Project. West J Emerg Med 2021; 22:462-470. [PMID: 34125015 PMCID: PMC8203029 DOI: 10.5811/westjem.2021.3.51925] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 03/01/2021] [Accepted: 03/02/2021] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION In addition to the nearly 40,000 firearm deaths each year, nonfatal firearm injuries represent a significant public health burden to communities in the United States. We aimed to describe the incidence and rates of nonfatal firearm injuries. METHODS We calculated nonfatal firearm injury estimates using the Healthcare Cost and Utilization Project of the Agency for Healthcare Research and Quality, including the Nationwide Emergency Department Samples and the National Inpatient Samples. We used the International Classification of Diseases, 10th Revision, Clinical Modification to identify firearm injury episodes. Deaths in the emergency department (ED) or as inpatients were excluded. RESULTS In addition to the 118,171 persons shot and killed by firearms from 2016-2018, 228,380 people were shot (ratio 1.9:1) and treated at a hospital ED or admitted to hospital, a rate of 23.4 nonfatal firearm injury episodes per 100,000 population. The number of nonfatal injury episodes varied by year: 2018 had the lowest at 69,692, compared to 84,776 in 2017 and 73,912 in 2016. Unintentional injury episodes were the most frequent, accounting for 58.5% (n = 81,217) and 38.9% (n = 34,820) of total nonfatal firearm hospital discharges from the ED and inpatients, respectively. Assault episodes were the next most frequent, at 36.3% (n = 50,482) of ED and 49.5% (n = 44,290) of inpatient discharges. The highest rate of nonfatal firearm injury by five-year age group was for 20- to 24-year-olds. With an annual rate of 73.53 per 100,000 population, the rates for ages 20-24 were more than 10 times higher than the rates for patients younger than 15 or 60 years and older. More than half (53.4%, n = 121,884) of hospital-treated, nonfatal firearm injury episodes were patients living in ZIP codes with a median household income in the lowest quartile, compared to 7.5% (n = 17,102) for patients residing in the highest income quartile ZIP codes, a sevenfold difference. CONCLUSION For every person shot and killed by a gun in the US, two more are wounded. Unlike firearm deaths, which are predominantly suicides, most nonfatal firearm injury episodes are unintentional or with an assault intent. Having a reliable source of nonfatal injury data is essential to understanding the incidence of firearm injuries.
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Affiliation(s)
| | | | - Ted R. Miller
- Pacific Institute for Research and Evaluation, Calverton, Maryland
| | | | - David I. Swedler
- Pacific Institute for Research and Evaluation, Calverton, Maryland
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Lyons VH, Floyd AS, Griffin E, Wang J, Hajat A, Carone M, Benkeser D, Whiteside LK, Haggerty KP, Rivara FP, Rowhani-Rahbar A. Helping individuals with firearm injuries: A cluster randomized trial. J Trauma Acute Care Surg 2021; 90:722-730. [PMID: 33405475 PMCID: PMC7979484 DOI: 10.1097/ta.0000000000003056] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Patients with firearm injuries are at high risk of subsequent arrest and injury following hospital discharge. We sought to evaluate the effect of a 6-month joint hospital- and community-based low-intensity intervention on risk of arrest and injury among patients with firearm injuries. METHODS We conducted a cluster randomized controlled trial, enrolling patients with firearm injuries who received treatment at Harborview Medical Center, the level 1 trauma center in Seattle, Washington, were 18 years or older at the time of injury, spoke English, were able to provide consent and a method of contact, and lived in one of the five study counties. The intervention consisted of hospital-based motivational interviewing, followed by a 6-month community-based intervention, and multiagency support. The primary outcome was the risk of subsequent arrest. The main secondary outcome was the risk of death or subsequent injury requiring treatment in the emergency department or hospitalization. RESULTS Neither assignment to or engagement with the intervention, defined as having at least 1 contact point with the support specialist, was associated with risk of arrest at 2 years post-hospital discharge (relative risk for intervention assignment, 1.15; 95% confidence interval, 0.90-1.48; relative risk for intervention engagement, 1.07; 95% confidence interval, 0.74-2.19). There was similarly no association observed for subsequent injury. CONCLUSIONS This study represents one of the first randomized controlled trials of a joint hospital- and community-based intervention delivered exclusively among patients with firearm injuries. The intervention was not associated with changes in risk of arrest or injury, a finding most likely due to the low intensity of the program. LEVEL OF EVIDENCE Care management, level II.
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Affiliation(s)
- Vivian H. Lyons
- Department of Health Behavior and Health Education, University of Michigan, Ann Arbor, MI
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, WA
- Firearm Injury & Policy Research Program, Harborview Injury Prevention & Research Center, University of Washington, Seattle, WA
| | - Anthony S. Floyd
- Firearm Injury & Policy Research Program, Harborview Injury Prevention & Research Center, University of Washington, Seattle, WA
- Alcohol & Drug Abuse Institute, University of Washington, Seattle, WA
| | - Elizabeth Griffin
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, WA
| | - Jin Wang
- Firearm Injury & Policy Research Program, Harborview Injury Prevention & Research Center, University of Washington, Seattle, WA
| | - Anjum Hajat
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, WA
| | - Marco Carone
- Department of Biostatistics, University of Washington, Seattle, WA
| | - David Benkeser
- Department of Biostatistics and Bioinformatics, Emory University, Atlanta, GA
| | - Lauren K. Whiteside
- Firearm Injury & Policy Research Program, Harborview Injury Prevention & Research Center, University of Washington, Seattle, WA
- Department of Emergency Medicine, University of Washington, Seattle, WA
| | - Kevin P. Haggerty
- Firearm Injury & Policy Research Program, Harborview Injury Prevention & Research Center, University of Washington, Seattle, WA
- School of Social Work, University of Washington, Seattle, WA
- Social Development Research Group, University of Washington, Seattle, WA
| | - Frederick P. Rivara
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, WA
- Firearm Injury & Policy Research Program, Harborview Injury Prevention & Research Center, University of Washington, Seattle, WA
- Department of Pediatrics, School of Medicine, University of Washington, Seattle, WA
| | - Ali Rowhani-Rahbar
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, WA
- Firearm Injury & Policy Research Program, Harborview Injury Prevention & Research Center, University of Washington, Seattle, WA
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Peterson C, Kearns MC. Systematic Review of Violence Prevention Economic Evaluations, 2000-2019. Am J Prev Med 2021; 60:552-562. [PMID: 33608188 PMCID: PMC7987799 DOI: 10.1016/j.amepre.2020.11.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 11/06/2020] [Accepted: 11/09/2020] [Indexed: 11/28/2022]
Abstract
CONTEXT Health economic evaluations (e.g., cost-effectiveness analysis) can guide the efficient use of resources to improve health outcomes. This study aims to summarize the content and quality of interpersonal violence prevention economic evaluations. EVIDENCE ACQUISITION In 2020, peer-reviewed journal articles published during 2000-2019 focusing on high-income countries were identified using index terms in multiple databases. Study content, including violence type prevented (e.g., child abuse and neglect), outcome measure (e.g., abusive head trauma clinical diagnosis), intervention type (e.g., education program), study methods, and results were summarized. Studies reporting on selected key methods elements essential for study comparison and public health decision making (e.g., economic perspective, time horizon, discounting, currency year) were assessed. EVIDENCE SYNTHESIS A total of 26 economic evaluation studies were assessed, most of which reported that assessed interventions yielded good value for money. Physical assault in the community and child abuse and neglect were the most common violence types examined. Studies applied a wide variety of cost estimates to value avoided violence. Less than two thirds of the studies reported all the key methods elements. CONCLUSIONS Comprehensive data collection on violence averted and intervention costs in experimental settings can increase opportunities to identify interventions that generate long-term value. More comprehensive estimates of the cost of violence can improve opportunities to demonstrate how prevention investment can be offset through avoided future costs. Better adherence to health economic evaluation reporting standards can enhance comparability across studies and may increase the likelihood that economic evidence is included in violence prevention decision making.
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Affiliation(s)
- Cora Peterson
- National Center for Injury Prevention and Control, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia.
| | - Megan C Kearns
- National Center for Injury Prevention and Control, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia
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12
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Bongiorno DM, Badolato GM, Boyle M, Vernick JS, Levy JF, Goyal MK. United States trends in healthcare charges for pediatric firearm injuries. Am J Emerg Med 2021; 47:58-65. [PMID: 33773299 DOI: 10.1016/j.ajem.2021.03.046] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Revised: 03/08/2021] [Accepted: 03/08/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND From 2009 to 2016, >21,000 children died and an estimated 118,000 suffered non-fatal injuries from firearms in the United States. Limited data is available on resource utilization by injury intent. We use hospital charges as a proxy for resource use and sought to: 1) estimate mean charges for initial ED and inpatient care for acute firearm injuries among children in the U.S.; 2) compare differences in charges by firearm injury intent among children; and 3) evaluate trends in charges for pediatric firearm injuries over time, including within intent subgroups. METHODS In this repeated cross-sectional analysis of the 2009-2016 Nationwide Emergency Department Sample, we identified firearm injury cases among children aged ≤19 years using ICD-9-CM and ICD-10-CM external cause of injury codes (e-codes). Injury intent was categorized using e-codes as unintentional, assault-related, self-inflicted, or undetermined. Linear regressions utilizing survey weighting were used to examine associations between injury intent and healthcare charges, and to evaluate trends in mean charges over time. RESULTS Among 21,951 unweighted cases representing 102,072 pediatric firearm-related injuries, mean age was 16.6 years, and a majority were male (88.2%) and publicly insured (51.5%). Injuries were 53.9% assault-related, 37.7% unintentional, 1.8% self-inflicted, and 6.7% undetermined. Self-inflicted injuries had higher mean charges ($98,988) than assault-related ($52,496) and unintentional ($28,618) injuries (p < 0.001). Self-inflicted injuries remained associated with higher mean charges relative to unintentional injuries, after adjusting for patient demographics, hospital characteristics, and injury severity (p = 0.015). Mean charges for assault-related injuries also remained significantly higher than charges for unintentional injuries in multivariable models (p < 0.001). After adjusting for inflation, mean charges for pediatric firearm-related injuries increased over time (p-trend = 0.018) and were 23.1% higher in 2016 versus 2009. Mean charges increased over time among unintentional injuries (p-trend = 0.002), but not among cases with assault-related or self-inflicted injuries. CONCLUSIONS Self-inflicted and assault-related firearm injuries are associated with higher mean healthcare charges than unintentional firearm injuries among children. Mean charges for pediatric firearm injuries have also increased over time. These findings can help guide prevention interventions aimed at reducing the substantial burden of firearm injuries among children.
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Affiliation(s)
- Diana M Bongiorno
- Johns Hopkins School of Medicine and Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America.
| | - Gia M Badolato
- Division of Emergency Medicine and Trauma Services, Children's National Health System, Washington, DC, United States of America.
| | - Meleah Boyle
- Division of Emergency Medicine and Trauma Services, Children's National Health System, Washington, DC, United States of America.
| | - Jon S Vernick
- Health Policy and Management, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, United States of America.
| | - Joseph F Levy
- Health Policy and Management, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, United States of America.
| | - Monika K Goyal
- Division of Emergency Medicine and Trauma Services, Children's National Health System and George Washington University, Washington, DC, United States of America.
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Richardson JB, Wical W, Kottage N, Chaudhary M, Galloway N, Cooper C. The Challenges and Strategies of Affordable Care Act Navigators and In-Person Assisters with Enrolling Uninsured, Violently Injured Young Black Men into Healthcare Insurance Coverage. Am J Mens Health 2021; 15:15579883211005552. [PMID: 33845662 PMCID: PMC8047839 DOI: 10.1177/15579883211005552] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 02/24/2021] [Accepted: 03/04/2021] [Indexed: 12/04/2022] Open
Abstract
Low-income young Black men experience a disproportionate burden of violent injury in the United States. These men face significant disparities in healthcare insurance coverage and access to care. The Affordable Care Act (ACA) created a new healthcare workforce, Navigators and In-Person Assisters (IPAs), to support low-income minority populations with insurance enrollment. Using a longitudinal qualitative case study approach with Navigators and IPAs at the two busiest urban trauma centers in Maryland, this study identifies the culturally and structurally responsive enrollment strategies used by three Navigators/IPAs as they enrolled violently injured young Black men in healthcare insurance coverage. These approaches included gaining their trust and building rapport and engaging female caregivers during enrollment. Navigators and IPAs faced significant barriers, including identity verification, health literacy, privacy and confidentiality, and technological issues. These findings offer novel insight into the vital work performed by Navigators and IPAs, as they attempt to decrease health disparities for young Black male survivors of violence. Despite high rates of victimization due to violent firearm injury, little is known about how this population gains access to healthcare insurance. Although the generalizability of this research may be limited due to the small sample size of participants, the qualitative case study approach offers critical exploratory data suggesting the importance of trauma-informed care in insurance enrollment by Navigators and IPAs. They also emphasize the need to further address structural issues, which affect insurance enrollment and thus undermine the well-being of young Black men who have survived violent injury.
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Affiliation(s)
- Joseph B. Richardson
- Department of African-American Studies, Department of Anthropology, College of Behavioral and Social Sciences, University of Maryland College Park, College Park, MD, USA
| | - William Wical
- Department of African-American Studies, Department of Anthropology, College of Behavioral and Social Sciences, University of Maryland College Park, College Park, MD, USA
| | - Nipun Kottage
- Department of African-American Studies, Department of Anthropology, College of Behavioral and Social Sciences, University of Maryland College Park, College Park, MD, USA
| | - Mihir Chaudhary
- Department of Surgery, University of California San Francisco-East Bay, Oakland, CA, USA
| | - Nicholas Galloway
- Department of African-American Studies, Department of Anthropology, College of Behavioral and Social Sciences, University of Maryland College Park, College Park, MD, USA
| | - Carnell Cooper
- School of Medicine, University of Maryland Medical Center, Baltimore, MD, USA
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Lumba-Brown A, Batek M, Choi P, Keller M, Kennedy R. Mentoring Pediatric Victims of Interpersonal Violence Reduces Recidivism. JOURNAL OF INTERPERSONAL VIOLENCE 2020; 35:4262-4275. [PMID: 29294791 DOI: 10.1177/0886260517705662] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Pediatric interpersonal violence is a public health crisis resulting in morbidity and mortality and recidivism. St. Louis City and surrounding areas have the highest rates of youth interpersonal violence nationally. St. Louis Children's Hospital (SLCH) Social Work in conjunction with Pediatric Emergency Medicine established a novel emergency department (ED)-initiated program to determine whether co-location of services followed by outpatient mentoring reduced the rate of morbidity, mortality, and recidivism in youths experiencing interpersonal violence. SLCH developed the "Empowering Youth Through Interpersonal Violence Prevention Program," co-locating initial social work services and emergency medical services in the pediatric ED. Youths, ages 8 to 17 years, presenting for interpersonal violence were approached for immediate social work counseling and subsequent individualized outpatient mentoring, developed from national best practices and model programs. A prospective 2:1 randomized, controlled pilot study assessing for youth morbidity, mortality, and recidivism was conducted for program service feasibility from 2012 to 2014. The study was followed by a 1-year retrospective analysis of program service integration as a hospital standard-of-care evaluating the same outcome measures. Of the 24 youths who participated in the pilot study and received the intervention, there was a 4% rate of morbidity and recidivism. Conversely, there was a 3.4% rate of mortality, 6.7% rate of morbidity, and 11.8% recidivism rate in those who refused to participate in services. EYIPP was offered as a service from 2014 to 2015 and 57 youths participated with a 3.5% rate of both morbidity and recidivism. During this time, 78 eligible youths declined services with a 1.1% rate of morbidity, and 2.3% recidivism rate. This novelprogram reduces recidivism, morbidity, and mortality in youths presenting to SLCH for interpersonal violence-related injuries suggesting that co-location of social services in the ED, followed by individualized mentoring may be important for engagement.
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Affiliation(s)
| | - Margie Batek
- Washington University School of Medicine in St. Louis, MO, USA
| | - Pamela Choi
- Washington University School of Medicine in St. Louis, MO, USA
| | - Martin Keller
- Washington University School of Medicine in St. Louis, MO, USA
| | - Robert Kennedy
- Washington University School of Medicine in St. Louis, MO, USA
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15
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16
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Abstract
Hoping to reduce the number of repeat visitors, one Washington, D.C., hospital is providing short- and long-term support to victims of violence.
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Affiliation(s)
- T R Goldman
- This article is part of a series on transforming health systems published with support from The Robert Wood Johnson Foundation. This is an open access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, which permits others to distribute, remix, adapt, and build upon this work, for commercial use, provided the original work is properly cited. See https://creativecommons.org/licenses/by/4.0/ . T. R. Goldman ( trgoldman1@gmail. com ) is a Washington, D.C.-based freelance journalist
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17
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Irvin N. Commentary: Using a Trauma-Informed Care Framework to Address the Upstream and Downstream Correlates of Youth Violence. Ann Emerg Med 2019; 74:S55-S58. [PMID: 31655678 DOI: 10.1016/j.annemergmed.2019.08.451] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Nathan Irvin
- Johns Hopkins University School of Medicine, Baltimore, MD.
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18
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Fischer KR, Schwimmer H, Purtle J, Roman D, Cosgrove S, Current JJ, Greene MB. A Content Analysis of Hospitals' Community Health Needs Assessments in the Most Violent U.S. Cities. J Community Health 2019; 43:259-262. [PMID: 28852912 DOI: 10.1007/s10900-017-0413-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The emergence of evidence-supported interventions allows hospitals the opportunity to reduce future reinjury among patients who are violently injured. However, hospital knowledge of these interventions and their perceived role in violence prevention is unknown. The Patient Protection and Affordable Care Act created new legal requirements for non-profit hospitals to conduct community health needs assessments (CHNA) every three years to maintain not-for-profit status. In turn, this allows an empiric evaluation of hospital recognition and response to community violence. To do so, this study performed a content analysis of hospital CHNAs from the 20 U.S. cities with the highest violent crime rates. A total of 77 CHNAs were examined for specific violence-related keywords as well as whether violence prevention was listed as a priority community need. Overall, 74% of CHNAs mentioned violence-related terms and only 32% designated violence prevention as a priority need. When discussed, 88% of CHNAs referenced community violence, 42% intimate partner or sexual violence, and 22% child abuse. This study suggests that hospitals may lack awareness of violence as an actionable, preventable public health issue. Further, evidence-based program models are available to hospitals that can reduce the recurrence of assaultive injuries.
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Affiliation(s)
- Kyle R Fischer
- Department of Emergency Medicine, University of Maryland School of Medicine, 6th Floor, Suite 200, 110 South Paca Street, Baltimore, MD, 21201, USA.
| | | | - Jonathan Purtle
- Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
| | | | - Shannon Cosgrove
- Cure Violence, University of Illinois at Chicago, Chicago, IL, USA
| | - J J Current
- MedStar Washington Hospital Center, Washington, DC, USA
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19
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Fischer KR, Bakes KM, Corbin TJ, Fein JA, Harris EJ, James TL, Melzer-Lange MD. Trauma-Informed Care for Violently Injured Patients in the Emergency Department. Ann Emerg Med 2018; 73:193-202. [PMID: 30503381 DOI: 10.1016/j.annemergmed.2018.10.018] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Revised: 10/08/2018] [Accepted: 10/11/2018] [Indexed: 10/27/2022]
Abstract
Violent traumatic injury remains a common condition treated by emergency physicians. The medical management of these patients is well described and remains an area of focus for providers. However, violently injured patients disproportionately carry a history of physical and psychological trauma that frequently affects clinical care in the emergency department. The alteration of our clinical approach, taking into consideration how a patient's previous experiences influence how he or she may perceive and react to medical care, is a concept referred to as trauma-informed care. This approach is based on 4 pillars: knowledge of the effect of trauma, recognition of the signs and symptoms of trauma, avoidance of retraumatization, and the development of appropriate policies and procedures. Using this framework, we provide practical considerations for emergency physicians in the delivery of trauma-informed care for violently injured patients.
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Affiliation(s)
- Kyle R Fischer
- Department of Emergency Medicine, and University of Maryland School of Medicine, Baltimore, MD.
| | - Katherine M Bakes
- Department of Emergency Medicine, University of Colorado School of Medicine, Denver, CO
| | - Theodore J Corbin
- Department of Emergency Medicine, Drexel University College of Medicine, Philadelphia, PA
| | - Joel A Fein
- Departments of Pediatrics and Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Erica J Harris
- Department of Emergency Medicine, Einstein Medical Center Philadelphia, Philadelphia, PA
| | - Thea L James
- Department of Emergency Medicine, Boston Medical Center/Boston University School of Medicine, Boston, MA
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20
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Coupet E, Karp D, Wiebe DJ, Kit Delgado M. Shift in U.S. payer responsibility for the acute care of violent injuries after the Affordable Care Act: Implications for prevention. Am J Emerg Med 2018; 36:2192-2196. [PMID: 29653788 DOI: 10.1016/j.ajem.2018.03.070] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Revised: 03/27/2018] [Accepted: 03/27/2018] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Investment in violence prevention programs is hampered by lack of clearly identifiable stakeholders with a financial stake in prevention. We determined the total annual charges for the acute care of injuries from interpersonal violence and the shift in financial responsibility for these charges after the Medicaid expansion from the Affordable Care Act in 2014. METHODS We analyzed all emergency department (ED) visits from 2009 to 2014 with diagnosis codes for violent injury in the Nationwide Emergency Department Sample (NEDS). We used sample weights to estimate total charges with adjusted generalized linear models to estimate charges for the 15% of ED visits with missing charge data. We then calculated the share attributable by payer and determined the difference in proportion by payer from 2013 to 2014. RESULTS Between 2009 and 2013, the uninsured accounted for 28.2-31.3% of annual charges for the acute care of violent injury, while Medicaid was responsible for a similar amount (29.0-31.0%). In 2014, there were $10.7 billion in total charges for violent injury. Medicaid assumed the greatest share, 39.8% (95% CI: 38.0-41.5%, $3.5-5.1 billion), while the uninsured accounted for 23.6% (95% CI: 22.2-24.9%, $2.0-3.0 billion), and Medicare accounted for 7.8% (95% CI: 7.7-8.0%, $0.7-1.0 billion). CONCLUSION After Medicaid expansion, taxpayers are now accountable for nearly half of the $10.7 billion in annual charges for the acute care of violent injury in the U.S. These findings highlight the benefit to state Medicaid programs of preventing interpersonal violence.
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Affiliation(s)
- Edouard Coupet
- Master's in Health Policy Research Program, University of Pennsylvania, United States; Center for Emergency Care Policy and Research, Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, United States; Leonard Davis Institute of Health Economics, University of Pennsylvania, United States.
| | - David Karp
- Center for Emergency Care Policy and Research, Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, United States
| | - Douglas J Wiebe
- Center for Emergency Care Policy and Research, Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, United States; Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, United States; Penn Injury Science Center, University of Pennsylvania, United States; Leonard Davis Institute of Health Economics, University of Pennsylvania, United States
| | - M Kit Delgado
- Center for Emergency Care Policy and Research, Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, United States; Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, United States; Penn Injury Science Center, University of Pennsylvania, United States; Leonard Davis Institute of Health Economics, University of Pennsylvania, United States
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21
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The effects of health care-based violence intervention programs on injury recidivism and costs: A systematic review. J Trauma Acute Care Surg 2017; 81:961-970. [PMID: 27537505 DOI: 10.1097/ta.0000000000001222] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Youth violence affects thousands annually, with homicide being the third leading cause of death for those aged 10 to 24 years. This systematic review aims to evaluate the published evidence for the effects of health care-based violence intervention programs (VIPs), which focus on reducing recurrent presentations for injury due to youth violence ("recidivism"). METHODS Health literature databases were searched. Studies were retained if peer reviewed and if programs were health care based, focused on intentional injury, addressed secondary or tertiary prevention (i.e., preventing recidivism and reducing complications), included participants aged 14 to 25 years, had greater than 1-month follow-up, and evaluated outcomes. Studies of child and sexual abuse and workplace, intimate partner, and self-inflicted violence were excluded. Extracted data subject to qualitative analysis included enrollment and retention, duration of follow-up, services provided, statistical analysis, and primary and intermediate outcomes. RESULTS Of the 2,144 citations identified, 22 studies were included in the final sample. Twelve studies were randomized controlled trials representing eight VIPs. Injury recidivism was assessed in six (75%) of eight programs with a significant reduction in one (17%) of six programs. Of the randomized controlled trials showing no difference in recidivism, all were either underpowered or did not include a power analysis. Two observational studies also showed significant reduction in recidivism. Significant intermediate outcomes included increased service use, attitude change, and decreases in violence-related behavior. Reductions in injury recidivism led to reductions in health care and criminal justice system costs. CONCLUSIONS Three studies showing reduced injury recidivism and several studies showing positive intermediate outcomes identify VIPs as a promising practice. Many studies were limited by poor methodological quality, including high losses to follow-up. LEVEL OF EVIDENCE Systematic review, level III.
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Abstract
This paper examines an alternative solution for collecting reliable police shooting data. One alternative is the collection of police shooting data from hospital trauma units, specifically hospital-based violence intervention programs. These programs are situated in Level I trauma units in many major cities in USA. While the intent of these programs is to reduce the risk factors associated with trauma recidivism among victims of violent injury, they also collect reliable data on the number of individuals treated for gunshot wounds. While most trauma units do a great job collecting data on mode of injury, many do not collect data on the circumstances surrounding the injury, particularly police-involved shootings. Research protocol on firearm-related injury conducted in emergency departments typically does not allow researchers to interview victims of violent injury who are under arrest. Most victims of nonfatal police-involved shootings are under arrest at the time they are treated by the ED for their injury. Research protocol on victims of violent injury often excludes individuals under arrest; they fall under the exclusion criteria when recruiting potential participants for research on violence. Researchers working in hospital emergency departments are prohibited from recruited individuals under arrests. The trauma staff, particularly ED physicians and nurses, are in a strategic position to collect this kind of data. Thus, this paper examines how trauma units can serve as an alternative in the reliable collection of police shooting data.
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Purtle J, Adams-Harris E, Frisby B, Rich JA, Corbin TJ. Gender Differences in Posttraumatic Stress Symptoms Among Participants of a Violence Intervention Program at a Pediatric Hospital: A Pilot Study. FAMILY & COMMUNITY HEALTH 2016; 39:113-119. [PMID: 26882414 DOI: 10.1097/fch.0000000000000092] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Hospital-based violence intervention programs (HVIPs) have emerged as a strategy to address posttraumatic stress (PTS) symptoms among violently injured patients and their families. HVIP research, however, has focused on males and little guidance exists about how HVIPs could be tailored to meet gender-specific needs. We analyzed pediatric HVIP data to assess gender differences in prevalence and type of PTS symptoms. Girls reported more PTS symptoms than boys (6.96 vs 5.21, P = .027), particularly hyperarousal symptoms (4.00 vs 2.82, P = .002) such as feeling upset by reminders of the event (88.9% vs 48.3%, P = .005). Gender-focused research represents a priority area for HVIPs.
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Affiliation(s)
- Jonathan Purtle
- Department of Health Management & Policy, Drexel University School of Public Health Philadelphia, Pennsylvania (Drs Purtle and Rich); Department of Emergency Medicine, Drexel University College of Medicine, Philadelphia, Pennsylvania (Drs Adams-Harris and Corbin and Ms Frisby)
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24
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Noelker J. Gun violence prevention: Ripe for the entire medical community. Prev Med 2016; 82:7. [PMID: 26581668 DOI: 10.1016/j.ypmed.2015.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2015] [Accepted: 11/05/2015] [Indexed: 11/27/2022]
Affiliation(s)
- Joan Noelker
- Washington University in St. Louis Division of Emergency Medicine St. Louis, MO, USA
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Purtle J, Rich JA, Fein JA, James T, Corbin TJ. Hospital-Based Violence Prevention: Progress and Opportunities. Ann Intern Med 2015; 163:715-7. [PMID: 26301734 DOI: 10.7326/m15-0586] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Jonathan Purtle
- From Drexel University School of Public Health, The Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, and Drexel University College of Medicine, Philadelphia, Pennsylvania, and Boston University School of Medicine, Boston, Massachusetts
| | - John A. Rich
- From Drexel University School of Public Health, The Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, and Drexel University College of Medicine, Philadelphia, Pennsylvania, and Boston University School of Medicine, Boston, Massachusetts
| | - Joel A. Fein
- From Drexel University School of Public Health, The Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, and Drexel University College of Medicine, Philadelphia, Pennsylvania, and Boston University School of Medicine, Boston, Massachusetts
| | - Thea James
- From Drexel University School of Public Health, The Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, and Drexel University College of Medicine, Philadelphia, Pennsylvania, and Boston University School of Medicine, Boston, Massachusetts
| | - Theodore J. Corbin
- From Drexel University School of Public Health, The Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, and Drexel University College of Medicine, Philadelphia, Pennsylvania, and Boston University School of Medicine, Boston, Massachusetts
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26
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Purtle J, Cheney R, Wiebe DJ, Dicker R. Scared safe? Abandoning the use of fear in urban violence prevention programmes. Inj Prev 2015; 21:140-1. [PMID: 25805771 DOI: 10.1136/injuryprev-2014-041530] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Jonathan Purtle
- Department of Health Management & Policy, Drexel University School of Public Health, Philadelphia, Pennsylvania, USA
| | - Rose Cheney
- Department of Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Douglas J Wiebe
- Department of Biostatistics and Epidemiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Rochelle Dicker
- Department of General Surgery, University of California, San Francisco, San Fransisco, California, USA
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Fischer K, Purtle J, Corbin T. The Affordable Care Act's Medicaid expansion creates incentive for state Medicaid agencies to provide reimbursement for hospital-based violence intervention programmes. Inj Prev 2014; 20:427-30. [PMID: 24737797 DOI: 10.1136/injuryprev-2013-041070] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Kyle Fischer
- Department of Emergency Medicine, Center for Nonviolence & Social Justice, Drexel University College of Medicine, Philadelphia, Pennsylvania, USA
| | - Jonathan Purtle
- Department of Emergency Medicine, Center for Nonviolence & Social Justice, Drexel University College of Medicine, Philadelphia, Pennsylvania, USA
| | - Theodore Corbin
- Department of Emergency Medicine, Center for Nonviolence & Social Justice, Drexel University College of Medicine, Philadelphia, Pennsylvania, USA
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