A new model of clinical care incorporates a team-based public health approach to care for and manage violent injuries.
The innovative strategy which empowers health care professionals to prevent violent events, not just treat them, is used in more than 25 hospitals across the United States.
The programs are known as hospital-based violence intervention programs (HVIPs) and include teams of medical professionals, social workers, and researchers.
The professionals step in at a critical moment in a patient’s life — the period following a violent injury such as a gunshot or stab wound — with case management, counseling, and other services that help these victims break free from the cycle of violence.
The programs have grown from about six programs in 2009 as reports of their successes have accrued.
There is now evidence that HVIPs prevent violent reinjury and perpetration, reduce aggressive behaviors and improve employment, education, and healthcare utilization among program participants.
Researchers at Drexel University have recently published a study that systematically looked at the economic outcomes of hospital-based violence intervention.
They demonstrate that, in addition to transforming victims’ lives, these programs may indeed save a significant amount of money compared to non-intervention.
As reported in the American Journal of Preventive Medicine, an HVIP serving 90 clients could result in costs savings from tens of thousands of dollars to about four million in a five-year period.
“This is the first systematic economic evaluation of a hospital-based violence intervention program, and it’s done in a way that can be replicated as new evidence emerges about the programs’ impacts across different sectors,” said Jonathan Purtle, Dr.P.H., lead author of the simulation study.
Attaching dollars and cents to HVIPs, and knowing which sectors of society are likely to see the financial benefit, is important because many HVIPs lack a sustainable funding source.
Most programs currently rely on a patchwork of funders that may include some use of insurance billing for eligible services, such as behavioral counseling; private foundation grant or institutional funding; or local government funding.
Demonstrating that HVIPs are a source of long-term cost savings for the health care system or for the criminal justice system, or both, helps make the case that investing in HVIPs pays off.
Purtle’s study drew on the research literature about violent reinjury, violent perpetration, and estimates of the rates at which HVIPs prevent these outcomes.
He compared the costs of outcomes likely to be experienced by a hypothetical group of 90 individuals who received HVIP services (plus the costs of providing HVIP services to the 90 clients, $350,000 per year) to the costs of the outcomes likely to be experienced by a similar group of 90 individuals who did not receive HVIP services.
Care for a violent injury and a subsequent event incurs a variety of health care and societal costs. Expenditures include the actual costs of treating the individuals who are reinjured and/or treating their victims if those individuals go on to perpetrate violence against others.
Additionally, costs include the criminal justice fees to prosecute and incarcerate individuals who become perpetrators as well as societal costs of lost productivity.
In all models of the simulation, HVIPs produced cost savings over five years. The most conservative simulation, including only the future health care costs of those among the 90 individuals who may experience violent reinjury, showed health care savings of $82,765.
The most comprehensive model, including lost productivity costs, showed a societal cost savings of over four million to serve 90 clients.
Purtle noted that lost productivity costs, while common in economic analyses, may be somewhat unrealistically high because they assume all individuals in the model are employed.
Conversely, beyond the economic analysis there are still social benefits of HVIPs that aren’t easily quantifiable: “Even if the intervention cost a little more than it saved in dollars and cents to the health care system, there would still be a net benefit in terms of the violence it prevented,” Purtle said.
Source: Drexel University