The majority of cost in providing hospital service is related to buildings, equipment, salaried labor, and overhead, which are fixed over the short term. The high fixed costs emphasize the importance of adjusting fixed costs to patient consumption to maintain efficiency.

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PURPOSE We wanted to explore the associations between intimate partner violence (IPV) and comorbid health conditions, which have received little attention in male patients.METHODS Using a computer-based self-assessment health questionnaire, we screened sequential emergency department patients who were urban, male, and aged 18 to 55 years. We then examined associations between types of IPV disclosures, co-occurring mental health symptoms, and adverse health behaviors. RESULTSOf 1,669 men seeking nonurgent health care, 1,122 (67.2%) consented to be screened, and 1,026 (91%) completed the screening; 712 (63%) were in a relationship in the past year. Of these men, 261 (37%) disclosed IPV: 20% (n = 144) disclosed victimization only, 6% (n = 40) disclosed perpetration only, and 11% (n = 77) disclosed bidirectional IPV (defi ned as both victimization and perpetration in their relationships). Men disclosing both victimization and perpetration had the highest frequencies and levels of adverse mental health symptoms. Rates of smoking, alcohol abuse, and drug use were likewise higher in IPV-involved men.CONCLUSIONS A cumulative risk of poor mental health and adverse health behaviors was associated with IPV disclosures. Self-disclosure by men seeking acute health care provides the potential for developing tools to assess level of risk and to guide tailored interventions and referrals based on the sex of the patient. 2009;7:47-55. DOI: 10.1370/afm.936. Ann Fam Med INTRODUCTIONI ntimate partner violence (IPV), defi ned as a pattern of assaultive and coercive behaviors in intimate relationships, remains a major public health concern in the United States.1,2 The health care system advocates screening women for victimization and referring them to legal and community-based advocacy services. Both men and women, however, perpetrate a wide range of emotional and physical violence against their intimate partners, and 3-5 bidirectional IPV may be more common than generally recognized in medical settings. 6,7 Substance abuse and mental health problems have been found to be major cofactors in IPV, [8][9][10] and there is reason to believe that interventions aimed at reducing violent behavior will be only marginally effective if co-occurring mental health and substance abuse problems are ignored. [11][12][13][14][15] Recent research targeting substance use along with IPV behavior is promising. [16][17][18] The US Preventative Service Task Forces ranked the evidence in favor of routine screening for family violence as inconclusive and raised concerns for possible harm from retaliatory IPV after disclosure. Although it is reasonable to consider whether IPV-involved men could benefi t from treatment Karin V. Rhodes, MD 48 IN T IM AT E PA R T NER V IOL ENC Eunder a medical model, the topic requires more study. Numerous studies quantify the co-occurrence of IPV and adverse mental health symptoms and substance use in women patients, [19][20][21] but fewer address these issues in IPV-involved men. 22 In fact, there are few venues for ...

Study objective: Recent systematic reviews have noted a lack of evidence that screening for intimate partner violence does more good than harm. We assess whether patients screened for intimate partner violence on a computer kiosk in the emergency department (ED) experienced any adverse events during or subsequent to the ED visit and whether computer kiosk identification and referral of intimate partner violence in the ED setting resulted in safety behaviors or contact with referrals.Methods: We conducted a prospective, observational study in which a convenience sample of male and female ED patients triaged to the waiting room who screened positive (on a computer kiosk-based questionnaire) for intimate partner violence in the past year were provided with resources and information and invited to participate in a series of follow-up interviews. At 1-week and 3-month follow-up visits, we assessed intimate partner violence, safety issues, and use of resources. In addition, to obtain an objective measure of safety, we assessed the number of violence-related 911 calls to participant addresses within a call district 6 months before and 6 months after the index ED visit.Results: Of the 2,134 participants in a relationship in the last year, 548 (25.7%) screened positive for intimate partner violence. No safety issues, such as calling security or a partner's interference with the screening, occurred during the ED visit for any patient who disclosed intimate partner violence. Of the 216 intimate partner violence victims interviewed in person and 65 contacted by telephone 1 week later, no intimate partner violence victims reported any injuries or increased intimate partner violence resulting from participating in the study. For the sample in the local police district, there was no increase in the number of intimate partner violence victims who called 911 in the 6 months after the ED visit. Finally, 35% (n131) reported they had contacted community resources during the 3-month follow-up period.Conclusion: Among patients screening positive for intimate partner violence, there were no identified adverse events related to screening, and many had contacted community resources. Study objective: Recent systematic reviews have noted a lack of evidence that screening for intimate partner violence does more good than harm. We assess whether patients screened for intimate partner violence on a computer kiosk in the emergency department (ED) experienced any adverse events during or subsequent to the ED visit and whether computer kiosk identification and referral of intimate partner violence in the ED setting resulted in safety behaviors or contact with referrals. Comments Postprint version. Published inMethods: We conducted a prospective, observational study in which a convenience sample of male and female ED patients triaged to the waiting room who screened positive (on a computer kioskbased questionnaire) for intimate partner violence in the past year were provided with resources and information and invited to participate in a ...

These findings suggest that IPV takes a greater mental than physical toll (for both sexes) and that as IPV severity increases, mental health functioning diminishes and self-advocacy behaviors increase. Additionally, as perceived danger increases, both physical and mental health status worsens. This has important implications for clinicians to assess and consider IPV victims' perceptions of their situations relative to danger, not just the levels of abuse they are experiencing.