Hospital-centered violence intervention programs: a cost-effectiveness analysis

Chong, Vincent; Smith, Randi N.; Garcia, Arturo; Lee, Wayne S.; Ashley, Linnea; Marks, Anne; Liu, Terrence H.; Victorino, Gregory P.

doi:10.1016/j.amjsurg.2014.11.003

Cited by 71 publications

(38 citation statements)

References 13 publications

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“…Furthermore, given the excess risk for future victimization among those presenting with assault injury, particularly firearm injuries (37), prevention resources should also be considered for this group, even among those with low SaFETy scores. Previous violence prevention programs have been shown to be cost-effective (38–42), specifically with regard to the costs of treating repeated violent injuries (38, 39) and preventing incarceration due to violence-related offenses (38, 40). Given that the average ED visit for a firearm assault costs $1200 and average inpatient costs approach $24 000 (43), even a moderately effective prevention program directed at individuals in higher-risk strata would be cost-effective.…”

Section: Discussionmentioning

confidence: 99%

Development of the SaFETy Score: A Clinical Screening Tool for Predicting Future Firearm Violence Risk

et al. 2017

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Background Interpersonal firearm violence among youth is a substantial public health problem, and emergency department (ED) physicians require a clinical screening tool to identify high-risk youth. Objective To derive a clinically feasible risk index for firearm violence. Design 24-month prospective cohort study. Setting Urban, level 1 ED. Participants Substance-using youths, aged 14 to 24 years, seeking ED care for an assault-related injury and a proportionately sampled group of non–assault-injured youth enrolled from September 2009 through December 2011. Measurements Firearm violence (victimization/perpetration) and validated questionnaire items. Results A total of 599 youths were enrolled, and presence/absence of future firearm violence during follow-up could be ascertained in 483 (52.2% were positive). The sample was randomly split into training (75%) and post–score-construction validation (25%) sets. Using elastic-net penalized logistic regression, 118 baseline predictors were jointly analyzed; the most predictive variables fell predominantly into 4 domains: violence victimization, community exposure, peer influences, and fighting. By selection of 1 item from each domain, the 10-point SaFETy (Serious fighting, Friend weapon carrying, community Environment, and firearm Threats) score was derived. SaFETy was associated with firearm violence in the validation set (odds ratio [OR], 1.47 [95% CI, 1.23 to 1.79]); this association remained (OR, 1.44 [CI, 1.20 to 1.76]) after adjustment for reason for ED visit. In 5 risk strata observed in the training data, firearm violence rates in the validation set were 18.2% (2 of 11), 40.0% (18 of 45), 55.8% (24 of 43), 81.3% (13 of 16), and 100.0% (6 of 6), respectively. Limitations The study was conducted in a single ED and involved substance-using youths. SaFETy was not externally validated. Conclusion The SaFETy score is a 4-item score based on clinically feasible questionnaire items and is associated with firearm violence. Although broader validation is required, SaFETy shows potential to guide resource allocation for prevention of firearm violence. Primary Funding Source National Institute on Drug Abuse R01024646.

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Section: Discussionmentioning

confidence: 99%

Development of the SaFETy Score: A Clinical Screening Tool for Predicting Future Firearm Violence Risk

et al. 2017

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“…2 Recurrent injury is a promising target for prevention, as prior injury is a predictor of future violent injury 3 and death. 4–6 Hospital-based violence intervention programs show promising results with in reducing re-injury and costs by using an initial injury visit to initiate prevention, 7,8 but appropriately scaling and distributing violence prevention resources requires a more accurate understanding of the incidence, risk factors, and impact of recurrent violent injury.…”

Section: Introductionmentioning

confidence: 99%

“…Although recurrent violent injury has been studied since the 1980s, prior studies have tracked recurrent visits limited to an individual trauma center, 7,9–16 a particular intervention or cohort study, 17–19 or a local area, 3,20,21 and many have combined results for both violent and nonviolent injuries. Most report a rate of recurrence of 10–25% over 2–5 years.…”

Section: Introductionmentioning

confidence: 99%

“…21 A recent, prospective cohort study of violently injured youth in Flint, Michigan that incorporated the full range of injury severity found a 37% recurrence rate within 2 years. 27 Past studies have reported costs of recurrent violent injuries in small cohorts, 7,8 but not population-level costs. Although many injured patients are treated in non-trauma center hospitals, 28 these institutions’ role in violence prevention is not established.…”

Section: Introductionmentioning

confidence: 99%

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Recurrent violent injury: magnitude, risk factors, and opportunities for intervention from a statewide analysis

Kaufman

Rising

Wiebe

et al. 2016

The American Journal of Emergency Medicine

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Introduction Though preventing recurrent violent injury is an important component of a public health approach to interpersonal violence, and a common focus of violence intervention programs, the true incidence of recurrent violent injury is unknown. Prior studies have reported recurrence rates from 0.8% to 44%, and risk factors for recurrence are not well established. Methods We used a statewide, all-payer database to perform a retrospective cohort study of emergency department visits for injury due to interpersonal violence in Florida, following patients injured in 2010 for recurrence through 2012. We assessed risk factors for recurrence with multivariable logistic regression and estimated time to recurrence with the Kaplan-Meier method. We tabulated hospital charges and costs for index and recurrent visits. Results Of 53,908 patients presenting for violent injury in 2010, 11.1% had a recurrent violent injury during the study period. Trauma centers treated 31.8%, including 55.9% of severe injuries. Among recurrers, 58.9% went to a different hospital for their second injury. Low income, homelessness, Medicaid or uninsurance, and Black race were associated with increased odds of recurrence. Patients with visits for mental and behavioral health and unintentional injury also had increased odds of recurrence. Index injuries accounted for $105 million in costs, and recurrent injuries accounted for another $25.3 million. Conclusions Recurrent violent injury is a common and costly phenomenon, and effective violence prevention programs are needed. Prevention must include the non-trauma centers where many patients seek care.

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“…Several studies have found that HVIPs are effective in collecting violent injury data and that they can reduce repeat violent injury and the costs associated with injury. [21][22][23] These programs collect data on the mode of injury (i.e., gunshot wound or GSW) as well as data on the context and circumstances surrounding the violent injury. HVIPs collect data on the circumstances of the injury in ways similar to data collected by the FBI and NLEOMF on officers' shot in the line of duty.…”

Section: Hospital Violence Intervention Programsmentioning

confidence: 99%

Who Shot Ya? How Emergency Departments Can Collect Reliable Police Shooting Data

Richardson¹,

Vil

Cooper

2015

J Urban Health

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This paper examines an alternative solution for collecting reliable police shooting data. One alternative is the collection of police shooting data from hospital trauma units, specifically hospital-based violence intervention programs. These programs are situated in Level I trauma units in many major cities in USA. While the intent of these programs is to reduce the risk factors associated with trauma recidivism among victims of violent injury, they also collect reliable data on the number of individuals treated for gunshot wounds. While most trauma units do a great job collecting data on mode of injury, many do not collect data on the circumstances surrounding the injury, particularly police-involved shootings. Research protocol on firearm-related injury conducted in emergency departments typically does not allow researchers to interview victims of violent injury who are under arrest. Most victims of nonfatal police-involved shootings are under arrest at the time they are treated by the ED for their injury. Research protocol on victims of violent injury often excludes individuals under arrest; they fall under the exclusion criteria when recruiting potential participants for research on violence. Researchers working in hospital emergency departments are prohibited from recruited individuals under arrests. The trauma staff, particularly ED physicians and nurses, are in a strategic position to collect this kind of data. Thus, this paper examines how trauma units can serve as an alternative in the reliable collection of police shooting data.

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Hospital-centered violence intervention programs: a cost-effectiveness analysis

Cited by 71 publications

References 13 publications

Development of the SaFETy Score: A Clinical Screening Tool for Predicting Future Firearm Violence Risk

Development of the SaFETy Score: A Clinical Screening Tool for Predicting Future Firearm Violence Risk

Recurrent violent injury: magnitude, risk factors, and opportunities for intervention from a statewide analysis

Who Shot Ya? How Emergency Departments Can Collect Reliable Police Shooting Data

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