national health collaborative on violence and abuse | briefing violence against women, children and...
TRANSCRIPT
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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
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My sister Beth is a new mom
In 1981, I start medical school
We were both trying to learn how to save lives…
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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
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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
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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
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6
Abused women experience a
Abused Women Experience a
Campbell et al, 2002
in gynecological, neurological, and stress-related problems.
50% to 70% increase
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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
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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
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US medical costs for IPV in the year after victimization
9Brown et al, 2008
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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
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Another Cost: Impact on Children of Witnessing IPV
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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
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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
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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
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…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
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Kaiser Permanente’s Innovative Model
http://www.youtube.com/watch?v=uocoMbCg9N8
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The KP Systems-Model Approach
Inquiry and Referral
Supportive Environment
Leadershipand
Oversight
On-siteServices
CommunityLinkages
“Making the right thing easier to do”
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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
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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
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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
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Implementation of IPV Services Underway in Every KP Region
Group Health
Northern California
Northwest
Southern California
Colorado Ohio
Mid-Atlantic
Georgia
Hawaii
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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.”
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Looking toward the next decade…
We can transform the health care response to Domestic Violence
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Brigid McCaw, MD, MS, MPH, FACPMedical Director
Family Violence Prevention Program
The Permanente Medical Group
510-987-2035
kp.org/domesticviolence
Contact Information
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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
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END
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Stories of courage, survival, and hopewww.kp.org/domestic violence
Supportive EnvironmentWorkplace Awareness
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Cultural Competence Women’s HealthCulturally Competent Care
INQUIRY AND REFERRAL
IPV Chapter includes: Age (teens, elders) Ethnicity Life experiences Adverse Childhood Experiences (ACE)