Changes in Incidents and Payment Methods for Intimate Partner Violence Related Injuries in Women Residing in the United States, 2002 to 2015

BackgroundViolence in interpersonal relationships is a substantial health and social problem in the United States and is associated with a myriad of immediate and long-term physical, behavioral, and neurocognitive impairments. The present study sought to determine the incidence of U.S. emergency department (ED)-attended intimate partner violence (IPV) from 2002 to 2015 and examine the differences in payment sources before and after implementation of the Affordable Care Act.MethodsWe analyzed ED visits among female patients aged 15 years or older between 2002 and 2015 from the National Hospital Ambulatory Medical Care Survey. Using International Classification of Disease, Ninth Revision, Clinical Modification, codes from patient visit records, we classified each ED visit to determine the frequency and estimate the relative proportion and national frequency of IPV visits. We explored bivariate and multivariate associations between IPV-related injuries with age, race, ethnicity, method of payment, and region, noting changes over time.ResultsBetween 2002 and 2015, female patients visited EDs an estimated 2,576,417 times for IPV-related events, and the proportion of ED visits for IPV increased during that time period. The percentage of ED visits for IPV-related events did not differ significantly by region, race, or ethnicity. Compared with women 25–44 years of age, women aged 65 to 74 (odds ratio, 0.15; 95% confidence interval, 0.05–0.43; p < .001) and 75 years and older (odds ratio, 0.20; 95% confidence interval, 0.08–0.53; p = .001) were less likely to visit an ED for IPV. Women were more likely to pay for IPV-related services out-of-pocket (i.e., self-pay) (odds ratio, 1.85; 95% confidence interval, 1.24–277; p = .003) before the enactment of the Affordable Care Act.ConclusionsThe increase in the percentage of IPV-related ED claims paid by private insurance suggests that the Affordable Care Act may have increased women's willingness and ability to seek medical attention for IPV-related injuries and disclose IPV as the source of injuries.     

Patterns in US medical expenditures and utilization for injury, 1987.

This article is based on data released in 1991/93 from the 1987. National Medical Expenditure Survey. Medical spending and utilization patterns are analyzed for 13 major categories of injury. Medical spending on injury in 1987 was $64.7 billion in 1993 dollars. Nonhospitalized medically treated injuries averaged $571 in medical spending per case, $181 per visit, and 3.2 visits per injury. The prevalence-based survey estimate of medical spending on injuries during 1987 is 10% lower than the incidence-based estimates of lifetime medical spending resulting from injuries in 1985.     

Gender and physical violence

This study examines incidents of physical violence in relation to the sex of both assault victim and attacker. A survey of all assault victims attending an urban accident and emergency department (AED) in Norway during a 2-year period was carried out. All the assault victims were interviewed using a structured questionnaire administered by the attending physician as part of the initial consultation at the AED. During this interview, information about the victims, the attackers and the assaults was collected from the victims. Information on the sex, age, alcohol state of victims, and any referral to hospitals and specialists, was collected from the victim's medical notes at the AED. The severity of the victim's injuries was rated retrospectively using Abbreviated Injury Scale (AIS) and Shepherd's Injury Severity Scale for rating of injuries of assault. A total of 1234 men (74%) were attacked by other men, 354 women (21%) were attacked by men, 33 men (2%) by women, and 59 women (4%) by other women. The characteristics of the assaults carried out amongst female victim-female attacker and male victim-male attacker groups had many similarities. The same was found for the female victim-male attacker and male victim-female attacker groups. We conclude that changes in the traditional behaviour associated with women and men in relation to physical violence may be taking place.     

Adult Sexual Assault Evaluations at Rhode Island Emergency Departments, 1995–2001

The objectives of this study were to estimate the incidence and identify the temporal patterns of visits to Rhode Island emergency departments (EDs) by adults who were sexually assaulted. Visits to all Rhode Island EDs from January 1995–June 2001 by adults who were sexually assaulted were identified using International Classification of Disease, Ninth Revision, Clinical Modification (ICD-9) codes. Medical records of these visits were reviewed. Frequency distributions of the assault characteristics and patient demographics were generated. Incidence rates (IRs) of ED visits after sexual assault were estimated using 2000 US Census data. Analyses of the temporal patterns of the ED visits after sexual assault were conducted. Of the 823 ED visits, 796 (96.7%) were by females and 27 (3.3%) were by males. The median age for females was 25 years (range, 18–96 years) and was 28 years (range, 18–87 years) for males. Among the female patients, 76.6% sustained a vaginal/anal assault. Among the male patients, 59.3% sustained an anal assault. The average annual IR of ED visits after sexual assault was 30.3/100,000/year for females and 1.2/100,000/year for males, which is a 25-fold greater incidence of these visits for females than males. ED visits after adult sexual assault were more frequent during warmer months and around 5 p.m. There was a gradual 43% increase in the IRs of ED visits after sexual assault over the 6.5-year period. These findings should help direct EDs to maximize supportive services when they are needed most often.     

Surveillance and assessment of workplace assault injuries: analysis of Rhode Island workers' compensation claims 1998-2002

OBJECTIVE: To analyze workplace assault by rate, injury severity, and trends using Rhode Island workers' compensation claim data. METHOD: A total of 6402 workers' compensation assault claims from Rhode Island for the period of 1998 through 2002 was analyzed. Data from the U.S. Department of Labor was used to derive estimates of injury rates. RESULTS: An average rate of 27.7 assaults per 10,000 workers was found and varied only marginally across years. Females filed 75% of all assault claims, though injuries to males resulted in longer periods of indemnification. The total cost of workplace assaults was 7,025,997 dollars, averaging 1097 dollars per claim, and average indemnification duration was 16.8 days per claim. While the assault rate was relatively stable, a notable decline in both cost and indemnification periods over time was discovered. CONCLUSION: The assault rate found was among the highest reported to date, demonstrating that workplace violence remains a significant threat to employee safety. While a decline in incident severity was discovered over time, many outcomes were still serious. Preventive interventions to reduce incidents of workplace assaults among groups at the highest risk should be given highest priority.     

Nonfatal self-inflicted injuries among adults aged > or = 65 years--United States, 2005

In 2005, an estimated 372,722 persons in the United States were treated in hospital emergency departments (EDs) for intentional, nonfatal self-inflicted injuries. Nonfatal self-inflicted injuries are most common among adolescents and young adults; few studies have investigated these types of injuries among adults aged > or =65 years. However, older adults are one of the fastest-growing population groups in the United States and can require more extensive and more costly medical treatment than younger adults. To characterize ED visits for nonfatal self-inflicted injuries among U.S. adults aged > or =65 years, CDC analyzed ED visits for 2005 using data from the National Electronic Injury Surveillance System All Injury Program (NEISS-AIP). This report summarizes the results of that analysis, which indicated that, in 2005, adults aged > or =65 years made an estimated 7,105 visits to EDs (i.e., 19.3 visits per 100,000 population) for nonfatal self-inflicted injuries, and ED health-care providers attributed 80.4% of these visits to suicidal behavior. In addition, a significantly higher percentage of adults aged > or =65 years compared with younger adults were hospitalized after ED visits for suicidal behavior. Comprehensive prevention strategies that combine community outreach, crisis intervention, and clinical management are needed to decrease morbidity and mortality from suicidal behavior among older adults.     

Ambulatory medical care utilization estimates for 2005

OBJECTIVE: This report presents statistics on ambulatory care visits to physician offices, hospital outpatient departments (OPDs), and hospital emergency departments (EDs) in the United States in 2005. Ambulatory medical care utilization is described in terms of patient, practice, facility, and visit characteristics. METHODS: Data from the 2005 National Ambulatory Medical Care Survey (NAMCS) and the National Hospital Ambulatory Medical Care Survey (NHAMCS) were combined to produce averaged annual estimates of ambulatory medical care utilization. RESULTS: Patients in the United States made an estimated 1.2 billion visits to physician offices and hospital OPDs and EDs, a rate of 4.0 visits per person annually. Between 1995 and 2005, population visit rates increased by about 20% in primary care offices, surgical care offices, and OPDs; 37% in medical specialty offices; and 7% in EDs. The aging of the population has contributed to increased volume of visits because older patients have higher visit rates. Visits by patients 40-59 years of age represented about 28.5 percent in 2005, compared with 23.9 percent in 1995. Black persons had higher visit rates than white persons to hospital OPDs and EDs, but lower visit rates to office-based primary care and to surgical and medical specialists. In the ED, the visit rate for patients with no insurance was about twice that of those with private insurance; whereas for all types of office-based care, the visit rates were higher for privately insured persons than for uninsured persons. About 29.4 percent of all ambulatory care visits were for chronic diseases and 25.2 percent were for preventive care, including checkups, prenatal care, and postsurgical care. The leading treatment provided at ambulatory care visits was medicinal with 71.3 percent of all visits having one or more medications prescribed, up by 10% since 1995 when encounters with drug therapy represented 64.9 percent of all visits. In 2005, 2.4 billion medications were prescribed or administered at these visits.     

National Hospital Ambulatory Medical Care Survey: 2002 emergency department summary

OBJECTIVES: This report describes ambulatory care visits to hospital emergency departments (EDs) in the United States. Statistics are presented on selected hospital, patient, and visit characteristics. Selected trends in ED utilization from 1992 through 2002 are also presented. METHODS: The data presented in this report were collected from the 2002 National Hospital Ambulatory Medical Care Survey (NHAMCS). NHAMCS is part of the ambulatory care component of the National Health Care Survey that measures health care utilization across various types of providers. NHAMCS is a national probability sample survey of visits to emergency and outpatient departments of non-Federal, short-stay, and general hospitals in the United States. Sample data are weighted to produce annual national estimates. RESULTS: During 2002, an estimated 110.2 million visits were made to hospital EDs, about 38.9 visits per 100 persons. From 1992 through 2002, an increasing trend in the ED utilization rate was observed for persons over 44 years of age. In 2002, abdominal pain, chest pain, fever, and cough were the leading patient complaints accounting for nearly one-fifth of all visits. Acute upper respiratory infection was the leading illness-related diagnosis at ED visits. From 1992 through 2002, decreases in ED visit rates were observed for intracranial injuries in children, and increases were found for depression in young adults and arthropathies among middle-aged and elderly patients. There were an estimated 39.2 million injury-related visits during 2002, or 13.8 visits per 100 persons. Diagnostic/screening services, procedures, and medications were provided at 86.8 percent, 43.2 percent, and 75.8 percent of visits, respectively. In 2002, approximately 12 percent of ED visits resulted in hospital admission. On average, patients spent 3.2 hours in the ED.     

Prevalence and risk factors of intimate partner violence in eighteen U.S. states/territories, 2005

BACKGROUND: Intimate partner violence (IPV) has been shown to have serious health consequences for both women and men, including poor general health, depressive symptoms, substance use, and elevated rates of chronic disease. Aside from crime surveys, there have been no large-scale IPV prevalence studies since the 1996 National Violence Against Women Survey. The lack of regular, ongoing surveillance, using uniform definitions and survey methods across states has hindered efforts to track IPV. In addition, the lack of state-specific data has hampered efforts at designing and evaluating localized IPV prevention programs. METHODS: In 2005, over 70,000 respondents were administered the first-ever IPV module within the Behavioral Risk Factor Surveillance System (BRFSS). The BRFSS is a Centers for Disease Control and Prevention-sponsored annual random-digit-dialed telephone survey, providing surveillance of health behaviors and health risks among the non-institutionalized adult population of the United States and several U.S. territories. RESULTS: Approximately 1 in 4 women and 1 in 7 men reported some form of lifetime IPV victimization. Women evidenced significantly higher lifetime and 12-month IPV prevalence, and were more likely to report IPV-related injury than men. IPV prevalence also varied by state of residence, race/ethnicity, age, income, and education. CONCLUSIONS: State-level data can assist state health officials and policy planners to better understand how many people have experienced IPV in their state. Such information provides a foundation on which to build prevention efforts directed toward this pervasive public health problem.     

Infectious diseases treated in emergency departments: United States, 2001

Emergency departments (EDs) are an important source of medical care in the United States. Information is limited concerning epidemiologic patterns of ED visits for infectious diseases. Data for 2001 from the National Hospital Ambulatory Medical Care Survey (NHAMCS) were analyzed for infectious disease visits. The NHAMCS is a national probability sample survey of visits to hospital EDs and outpatient departments of non-federal, short-stay, and general hospitals in the United States. Data are collected annually and are weighted to generate national estimates. In 2001, an estimated 19.8 million visits were made to hospital EDs for infectious diseases (rate=71 visits/1,000 persons). Children under 15 years old made 36% of these visits and had the highest rate of visits (rate=119 visits/1,000 persons). The rate of visits for females was 37% higher than for males (82 versus 60/1,000 persons). Although the white population had the highest volume of visits, the rate of visits for blacks was more than twice that of whites (130 versus 64 visits/1,000 persons). Laboratory tests were ordered in 84% of visits. An estimated 18% of visits to the EDs concern infectious diseases. The issue of health care access and ED use is complex and the reasons for the higher rate of visits for blacks than for whites are not fully understood.     

Vital Signs: Health Burden and Medical Costs of Nonfatal Injuries to Motor Vehicle Occupants — United States, 2012

Background

Motor vehicle crashes are a leading cause of death and injury in the United States. The purpose of this study was to describe the current health burden and medical and work loss costs of nonfatal crash injuries among vehicle occupants in the United States.

Methods

CDC analyzed data on emergency department (ED) visits resulting from nonfatal crash injuries among vehicle occupants in 2012 using the National Electronic Injury Surveillance System – All Injury Program (NEISS-AIP) and the Healthcare Cost and Utilization Project National Inpatient Sample (HCUP-NIS). The number and rate of all ED visits for the treatment of crash injuries that resulted in the patient being released and the number and rate of hospitalizations for the treatment of crash injuries were estimated, as were the associated number of hospital days and lifetime medical and work loss costs.

Results

In 2012, an estimated 2,519,471 ED visits resulted from nonfatal crash injuries, with an estimated lifetime medical cost of $18.4 billion (2012 U.S. dollars). Approximately 7.5% of these visits resulted in hospitalizations that required an estimated 1,057,465 hospital days in 2012.

Conclusions

Nonfatal crash injuries occur frequently and result in substantial costs to individuals, employers, and society. For each motor vehicle crash death in 2012, eight persons were hospitalized, and 100 were treated and released from the ED.

Implications for Public Health

Public health practices and laws, such as primary seat belt laws, child passenger restraint laws, ignition interlocks to prevent alcohol impaired driving, sobriety checkpoints, and graduated driver licensing systems have demonstrated effectiveness for reducing motor vehicle crashes and injuries. They might also substantially reduce associated ED visits, hospitalizations, and medical costs.     

Patients seen in emergency departments who had a prior visit within the previous 72 h-National Hospital Ambulatory Medical Care Survey, 2002

OBJECTIVE: This study characterized emergency department (ED) visits of patients who had received services in an ED within the previous 72 h. METHODS: ED data from the National Hospital Ambulatory Medical Care Survey were analysed for: (a) infectious-disease-related visits; (b) infectious-disease-related return visits; and (c) return visits reported within the previous 72 h for all visits. Data were collected from a nationally representative sample of hospital EDs and were weighted to generate national estimates. RESULTS: In 2002, an estimated 20.5 million ED visits occurred in the USA for infectious diseases, for a visit rate of 73/1,000 people. A total of 3.5 million total return visits to EDs occurred within 72 h, and 67% were for follow-up visits. An estimated 625,280 return visits were for infectious diseases (18% of total ED return visits); 72% of these were for follow-up services. For total visits and infectious-disease-related visits, the majority of return visits were reported among those aged 25--44 years and among females. DISCUSSION: Approximately seven of every 10 return visits to EDs in 2002 were for follow-up services, and no difference existed in the percentage of return visits for infectious diseases compared with total visits. A health services implication exists for treating this percentage of patients in EDs when primary care practitioners should be the point of contact.     

Epidemiology of injuries among women after physical assaults: the role of self-protective behaviors.

Physical assaults against women result in more than 5,000 deaths and 1 million nonfatal injuries per year in the United States. Data from the National Crime Victimization Survey, 1992-1995, were used to test the association between injury risk and self-protective behaviors, while controlling for victim, offender, and crime-related characteristics. Unlike in prior studies, a self-protective behavior measure that accounted for the temporal sequencing of the occurrence of injuries and self-protective behaviors was used. The study also examined whether the effect of self-protective behaviors varied as a function of victim-offender relationship status. The sample included 3,206 incidents in which females were physically assaulted by a lone male offender within the previous 6 months. Multivariate results revealed that women who used self-protective measures were less likely to be injured than were women who did not use self-protective measures or who did so only after being injured. The effect of self-protective behaviors on risk of injury did not vary as a function of the victim-offender relationship. The inverse association found between self-protective behaviors and injury risk differs from those of previous studies. Owing to inconsistent findings across studies, caution should be used when making recommendations to women regarding whether or not they should use self-protective behaviors during a physical assault.     

Heat Illness: Predictors of Hospital Admissions Among Emergency Department Visits—Georgia, 2002–2008

Heat-related illnesses (HRI) are the most frequent cause of environmental exposure-related injury treated in US emergency departments (ED). While most individuals with HRI evaluated in EDs are discharged to home, understanding predictors of individuals hospitalized with HRI may help public health practitioners and medical providers identify high risk groups who would benefit from educational outreach. We analyzed data collected by the Georgia Department of Public Health, Office of Health Indicators for Planning, regarding ED and hospital discharges for HRI, as identified by ICD-9 codes, between 2002 and 2008 to determine characteristics of individuals receiving care in EDs. Temperature data from CDC’s Environmental Public Health Tracking Network were linked to the dataset to determine if ED visits occurred during an extreme heat event (EHE). A multivariable logistic regression model was developed to determine characteristics predicting hospitalization versus ED discharge using demographic characteristics, comorbid conditions, socioeconomic status, the public health district of residence, and the presence of an EHE. Men represented the majority of ED visits (75 %) and hospitalizations (78 %). In the multivariable model, the odds of admission versus ED discharge with an associated HRI increased with age among both men and women, and odds were higher among residents of specific public health districts, particularly in the southern part of the state. Educational efforts targeting the specific risk groups identified by this study may help reduce the burden of hospitalization due to HRI in the state of Georgia.     

Supporting female survivors of intimate partner violence with disabilities: Recommendations for social workers in the emergency department

Intimate partner violence (IPV) is a pervasive problem with grave consequences. Women with disabilities are among the most vulnerable groups disproportionately affected, with higher IPV rates than either women without disabilities or men with disabilities. The emergency department (ED) in particular affords a gateway into health services for female survivors of IPV, placing ED social workers in a prime position to observe potential signs of IPV and connect survivors to further assistance. This article explores the critical role ED social workers can fill in addressing the needs of female survivors of IPV with disabilities. We begin by providing background on the characteristics of IPV among women with disabilities, followed by a discussion of the opportunities and challenges inherent to assessing and intervening with survivors. We conclude by outlining recommendations for working with female survivors of IPV with disabilities in EDs, using our previous research on the topic as a guide.     

Risk Factors for Severe Intimate Partner Violence and Violence-Related Injuries Among Women in India

Relying on an ecological framework, we examined risk factors for severe physical intimate partner violence (IPV) and related injuries among a nationally representative sample of women (N = 67,226) in India. Data for this cross-sectional study were derived from the 2005–2006 India National Family Health Survey, a nationally representative household-based health surveillance system. Logistic regression analyses were used to generate the study findings. We found that factors related to severe physical IPV and injuries included low or no education, low socioeconomic status, rural residence, greater number of children, and separated or divorced marital status. Husbands’ problem drinking, jealousy, suspicion, control, and emotionally and sexually abusive behaviors were also related to an increased likelihood of women experiencing severe IPV and injuries. Other factors included women’s exposure to domestic violence in childhood, perpetration of IPV, and adherence to social norms that accept husbands’ violence. Practitioners may use these findings to identify women at high risk of being victimized by severe IPV or injuries for prevention and intervention strategies. Policies and programs that focus on empowering abused women and holding perpetrators accountable may protect women at risk for severe IPV or injuries that may result in death.     

Injuries due to assaults on psychiatric hospital employees in Washington state

In order to estimate rates and identify risk factors for assaults on employees of a state psychiatric hospital, we examined workers' compensation claims, hospital-recorded incident reports, and data collected in a survey of ward staff. Results revealed 13.8 workers' compensation claims due to assault per 100 employees per year. Assaults were responsible for 60% of total claims. Incident reports revealed 35 injuries due to assault per 100 employees per year. Survey data revealed 415 injuries due to assault per 100 employees per year. Of the respondents, 73% reported at least a minor injury during the past year. Assault management training in the past year was associated with less severe injuries. Working in isolation, the occupation of mental health technician, and working on the geriatric-medical hospital unit were associated with more severe injuries during the past year. Assaults on staff in psychiatric hospitals represent a significant and underrecognized occupational hazard. Am. J. Ind. Med. 31:92–99 © 1997 Wiley-Liss, Inc.     

National Hospital Ambulatory Medical Care Survey: 2001 emergency department summary

OBJECTIVES: This report describes ambulatory care visits to hospital emergency departments (EDs) in the United States. Statistics are presented on selected hospital, patient, and visit characteristics. Selected trends in ED utilization from 1992 through 2001 are also presented. The report highlights new items on the continuity of care provided at ED visits, initial vital sign measurements, whether the patient's residence was a nursing home or institution, and duration of the ED visit. METHODS: The data presented in this report were collected from the 2001 National Hospital Ambulatory Medical Care Survey (NHAMCS). NHAMCS is part of the ambulatory care component of the National Health Care Survey that measures health care utilization across various types of providers. NHAMCS is a national probability sample survey of visits to emergency and outpatient departments of non-Federal, short-stay, and general hospitals in the United States. Sample data are weighted to produce annual national estimates. RESULTS: During 2001, an estimated 107.5 million visits were made to hospital EDs, about 38.4 visits per 100 persons. From 1992 through 2001, an increasing trend in the ED utilization rate was observed. Between 2 and 3 percent of ED visits were made by patients living in a nursing home or other institution. At approximately 3 percent of visits, the patient had been seen in the ED within the last 72 hours. In 2001, abdominal pain, chest pain, fever, and headache were the leading patient complaints accounting for nearly one-fifth of all visits. Acute upper respiratory infection was the leading illness-related diagnosis at ED visits. There were an estimated 39.4 million injury-related visits during 2001, or 14.1 visits per 100 persons. Diagnostic/screening services and procedures were provided at 85.4 percent and 40.9 percent of visits, respectively. Medications were provided at 74.2 percent of visits, and pain relief drugs accounted for 34.2 percent of the medications mentioned. In 2001, approximately 12 percent of ED visits resulted in hospital admission. On average, patients spent 3.0 hours in the ED.     

US emergency department costs: no emergency.

BACKGROUND: Many perceive emergency department (ED) overuse as an important cause of high medical care costs in the United States. Managed care plans and politicians have seen constraints on ED use as an important element of cost control. METHODS: We measured ED-associated and other medical care costs, using the recently released 1987 National Medical Expenditure Survey of approximately 35,000 persons in 14,000 households representative of the US civilian, noninstitutionalized population. RESULTS: In 1987, total ED expenditures were $8.9 billion, or 1.9% of national health expenditures. People with health insurance represented 86% of the population and accounted for 88% of ED spending. The uninsured paid 47% of ED costs themselves; free care covered only 10%. For the uninsured, the cost of hospitalization initiated by ED visits totaled $3.3 billion, including $1.1 billion in free care. Whites accounted for 75% of total ED costs. The ED costs of poor and near-poor individuals accounted for only 0.47% of national health costs. CONCLUSIONS: ED use accounts for a small share of US medical care costs, and cost shifting to the insured to cover free ED care for the uninsured is modest. Constraining ED use cannot generate substantial cost savings but may penalize minorities and the poor, who receive much of their outpatient care in EDs.