Reyes C, Hewitt CR, Clancy CM, Rudman WJ; Academy for Health Services Research and Health Policy. Meeting.
Abstr Acad Health Serv Res Health Policy Meet. 2000; 17: UNKNOWN.
Presented by: Carolina Reyes, M.D., Senior Scholar, AHQR, Department of Obstetrics and Gynecology, Cedars Sinai Medical Center, 8635 West Third Street, Suite 160W, Los Angeles, California 90048. Tel: 310-423-0967; Fax: 310-423-0140; E-mail: reyescx@cshs.org
Research Objective: Intimate partner violence is a public health problem affecting millions of U.S. women each year. The consequences of IPV are manifested in a range of health conditions as well as increased overall health care utilization. However, there is limited understanding of the clinical patterns associated with IPV. This study examines the documented prevalence of IPV victims within inpatient hospital populations; describes the clinical patterns associated with IPV and the charges per episode of care. Study Design: All cases containing IPV or family abuse ICD-9-CM codes (995.81-995.85) were abstracted from the 1995 and 1996 National Inpatient Sample (NIS) of the Healthcare Cost and Utilization Project (HCUP). The NIS is a 20% sample of all discharges from a representative sample of 900 US hospitals drawn from 19 states, weighted to reflect the US population. In this study, the age range was restricted to ages 16-56 in order to exclude child or elderly abuse. For all cases with these diagnostic codes, we ascertained their primary reason for admission. The primary diagnoses were categorized clinically using the 1998 AMA coding guidelines. Cost estimates of IPV based on the total hospital charges per episode of care were compared with non-IPV patients. The comparison groups of non-IPV patients were matched by age and primary diagnosis.Population Studied: Hospital Inpatient PopulationsPrincipal Findings: The overall documented prevalence rate of IPV for all inpatient hospitalizations in the HCUP-NIS data was estimated as 7 per 100,000 (N=787). Eight primary clinical conditions documented with an episode of IPV were 1) physical trauma (23%); 2) malnutrition (1%); 3) chronic disease (10%); 4) drug addiction (7%); 5) pregnancy complications (14%); 6) mental/emotional disorders (18%); 7) poisoning (6%); and 8) acute disease (20%). Prevalence rates by clinical category of IPV for females ranged from 1 in 1,246 for poisoning to 1 in 16,246 for chronic disease. Among female patients hospitalized for physical trauma the prevalence rate of documentation was 1 in 2,302. Total charges per episode of care ranged from $14,244.48 for physical trauma to $3,275.24 for drug addiction. In the three categories where the overall charges were the highest (physical trauma, chronic and acute disease) IPV victims had significantly higher total charges than non-IPV victims did. The low prevalence rate compared with other estimates of prevalence of IPV suggests substantial under-coding of IPV. Conclusion: The findings demonstrate a wider range of clinical conditions than commonly recognized to be associated with IPV. Cases with high resource intensive episodes of care have more diagnoses and have higher overall total charges than do non-IPV patients. The interpretation of these findings is limited due to significant under-coding for IPV. It is not clear whether under-coding reflects lack of recognition of IPV, concerns for patient safety and/or privacy, or other biases.Policy and Practice Implications: A greater understanding of the health consequences of IPV is essential to better define health care utilization patterns. Clinicians need a greater awareness of a wider range of clinical conditions associated with IPV. Future research should evaluate strategies for identifying barriers to recognition and coding of IPV to enhance recognition and appropriate interventions.Primary Funding Source: The Agency for Healthcare Quality and Research
Publication Types:
Keywords:
- Aged
- Case-Control Studies
- Child
- Chronic Disease
- Documentation
- Domestic Violence
- Female
- Health Personnel
- Humans
- Mental Disorders
- Physicians
- Pregnancy
- Prevalence
- Spouse Abuse
- United States
- Violence
- psychology
- hsrmtgs
Other ID:
UI: 102272739
From Meeting Abstracts