National Health Collaborative on Violence and Abuse | Briefing

1
Transforming the Health Care Response to
Domestic Violence
Brigid McCaw, MD, MPH, MS, FACPMedical Director,
Family Violence Prevention Program, Kaiser
Permanente

• National Health Collaborative on Violence and
  Abuse Briefing
• Violence Against Women, Children and Families
  New Health Policy Responses and Opportunities

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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
In the US, each year
New cases of breast cancer2 211,000 
Number of women dying from cardiovascular disease3 484,000 
Women who are injured from IPV4 2,000,000

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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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Abused women experience a

• Abused Women Experience a

in gynecological, neurological, and
stress-related problems.
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Campbell et al, 2002
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Higher Utilization of Health Care Services
BURNING PLATFORM

• 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
9
US medical costs for IPV in the year after
victimization
4 to 7 Billion
Brown 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 womens health services
• Womens Preventive Health Care Services Committee
  
• Universal screening for childbearing-age women
  recommended

15
Is it possible
to include prevention of Intimate Partner
Violence as part of routine health care services
for women?

• to include prevention of Intimate Partner
  Violence as part of routine health care services
  for women?

YES
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Kaiser Permanentes Innovative Model
http//www.youtube.com/watch?vuocoMbCg9N8
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The KP Systems-Model Approach
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
7106

1022

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Implementation of IPV Services Underway in Every
KP Region
Group Health
Northwest
Northern California
Ohio
Colorado
Mid-Atlantic
Southern California
Georgia
Hawaii
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Dr. Robert Pearl at CEO Breakfast sponsored by
Fortune Magazine
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.
Robert Pearl,MD The Permanente Medical Group 2007
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Looking toward the next decade
We can transform the health care response to
Domestic Violence
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Contact Information

• Brigid McCaw, MD, MS, MPH, FACP
• Medical Director
• Family Violence Prevention Program
• The Permanente Medical Group
• Brigid.McCaw_at_kp.org
• 510-987-2035
• kp.org/domesticviolence

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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-Violen
  ce-Against-Women-and-Children-Workshop-Summary.asp
  x
• 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?id23
  43
• Health Resource Center on Domestic Violence,
  Futures Without Violence http//www.futureswithout
  violence.org/content/features/detail/790/
• Kaiser Permanente Domestic Violence website
  kp.org/domesticviolence

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END
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Supportive Environment
Workplace Awareness
Stories of courage, survival, and
hope www.kp.org/domestic violence
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Cultural Competence
INQUIRY AND REFERRAL
Womens Health Culturally Competent Care

• IPV Chapter includes
• Age (teens, elders)
• Ethnicity
• Life experiences
• Adverse Childhood Experiences (ACE)