The Business Case for Intimate Partner Violence Intervention Programs in the Health Care Setting: Authors Pat Salber MD, MBA Lisa James MA, Family Violence Prevention Fund Editor Zita Surprenant MD, MPH, University of Kansas Medical Center Developed by: Physicians for a Violence-free Society & The Family Violence Prevention Fund

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 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 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 Increased injurious health behaviors Reduced preventive health behaviors Problems managing co-morbid conditions

Impact 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 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 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 Costly $1,775 more per year spent on victims Victims have 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 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. 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 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? 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 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? Routine Screening Support and Education Documentation Safety Assessment Referral

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 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 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 Costs Patient Population Eligible for Screening50,00050,00050,000 Estimated Patients Seen per Year25,00025,00025,000 Estimated DV Patients in Population Without Intervention Training With Intervention Training 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 Initial$6,000$60$60 Reinforcement$0$3,000$3,030 Total Licensed HCPs Initial$5,250$105$107 Reinforcement$0$2,625$2,678 Demographics/Target Population:Year IYear IIYear III

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 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 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

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