For Hospitals, Treating Violence Beyond the ER Is Good Medicine––and Good Business

About 300 centers have antiviolence programs

David Ross is a violence intervention specialist at the University of Maryland Medical Center. His team works with patients who are victims of violent injuries — stabbings, gunshots, or physical assaults — and who physicians flag as candidates for the program’s assistance. His challenge is to figure out the factors in their lives that put them at risk of violence.

Maryland is a pioneer in this type of coordinated effort, having launched its antiviolence program in 1998, according to a new report from Kaiser Health News (KHN).

Now, approximately 300 hospitals across the U.S., including the Children’s Hospital of Philadelphia and the University of Rochester Medical Center in New York, have developed similar initiatives. They follow Maryland’s “wraparound” approach, which involves following up with patients after they leave the hospital, and providing medical and social support to keep them out of harm’s way — by, for example, getting them into drug rehabilitation or education classes for people who have not finished high school. The hospitals are acting on the notion that keeping violent injury from recurring will ultimately reduce their expenses and improve people’s long-term health.

As experts increasingly view violence as a medical concern, hospitals see it as an opportunity. “There’s been a groundswell of professionals understanding that this is a public health issue,” said Dr. Rochelle Dicker, a trauma surgeon and professor at the University of California, San Francisco, who directs the UCSF Medical Center’s violence prevention program.

And the 2010 Patient Protection and Affordable Care Act supports that interest, KHN says. The act requires nonprofit hospitals to work harder if they want to maintain their tax-exempt status. Among other tasks, they have to formally measure their surrounding community’s health needs at least every three years and implement a strategy to address them.

To this end, a growing number of hospitals, especially those located in areas with high rates of violent crime, are partnering with local organizations to try to reduce neighborhood violence, Dr. Jonathan Purtle, an assistant professor at Drexel University, told KHN.

Research shows that if someone presents with a gunshot or stab wound and then, after leaving the hospital, returns to the same environment, there are good odds that person will be back in the emergency department. In addition, trends and anecdotal evidence suggest that people at higher risk for violent injury are likely to face issues such as domestic violence, mental illness, or substance abuse. They also often deal with other stressors, such as poverty or bad housing. These challenges can result in health problems, including lead poisoning and poor nutrition, which the hospital can work to address. Even if a facility can’t change, for instance, a neighborhood’s crime rate or drug culture, it can help someone get into rehab or find somewhere new to live.

Much of the growth in such hospital interventions has happened in the past five years, Dicker said.

“It’s becoming a more established understanding that this kind of violence is preventable,” said Dr. Rebecca Cunningham, an emergency medicine professor at the University of Michigan. “And we can have programs that can prevent it, and the hospital and emergency department are really critical locations for this.”

Source: Kaiser Health News; January 20, 2016.