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Expanding Access to Violence Intervention Programs: Analyzing Facility and Patient Characteristics
Sara Larosiliere
*3, Amir Ebadinejad
1, Jonathan Gates
1, Jane Keating
21Hartford Hospital, Hartford, CT; 2University of Connecticut, Farmington, CT; 3Frank H. Netter MD School of Medicine, North Haven, CT
Background: Violence intervention programs (VIPs) have emerged as a promising strategy to mitigate adverse outcomes for individuals affected by firearm violence. However, the extent to which these programs are utilized remains unclear. This study aims to compare patient demographics and clinical outcomes between facilities that offer VIP services and those that do not, while also identifying factors associated with VIP utilization.
Study Design: A retrospective cohort analysis was conducted using the National ACS COT Firearm Study Research Dataset. Adult patients were categorized based on the availability of VIP services at their treating facility and, within VIP facilities, by whether they received VIP services. Differences in demographics, injury characteristics, and clinical outcomes were analyzed using t-tests and Pearson chi-square tests. Multivariable logistic regression was performed to identify independent predictors of VIP utilization.
Results: Among 15,455 patients, 9,942 (64.3%) were treated at VIP facilities, while 5,513 (35.7%) were treated at non-VIP facilities. Patients at non-VIP facilities were significantly older (mean age: 30.3 vs. 29.8 years, p = 0.027) and had higher proportions of Black patients (64.3% vs. 60.7%, p < 0.001) and Hispanic ethnicity (18.2% vs. 8.9%, p < 0.001) compared to those at VIP facilities. Within VIP facilities, 8,101 (81.5%) did not receive VIP services, while 1,841 (18.5%) received VIP services. These patients that received VIP services were significantly younger (mean age: 27.84 vs. 30.25, p < 0.001) and had higher proportions of Black (72.8% vs, 58.0%, p < 0.001) Medicaid insurance (55.2% vs, 45.4%, p < 0.001), histories of mental illness (21.0% vs, 17.2%, p <0.001), prior incarceration (44.8% vs, 39.8%, p =0.026), and prior traumatic events (62.7% vs, 46.3%, p <0.001). Multivariable logistic regression identified Black race (OR= 1.97, CI=[1.59, 2.45], p < 0.001), Hispanic ethnicity (OR= 1.54, CI=[1.18, 2.00], p= 0.002), injury severity score (ISS) (OR= 1.04, CI=[1.03, 1.05], p <0.001), assault-related injury (OR= 6.41, CI= [4.26, 9.64], p <0.001), and history of mental illness (OR= 1.50, CI=[1.24,1.81], p < 0.001 as independent predictors of VIP utilization.
Conclusion: Our findings indicate that at hospitals that offer VIP services, Black patients, those with Medicaid, and individuals with a history of traumatic injury are more likely to receive VIP services, suggesting that these programs are reaching high-risk populations as intended. However, a minority of patients within VIP facilities received these services, highlighting the need for increased utilization. Additionally, non-VIP facilities treat a substantial number of patients with significant risk factors for recurrent violence yet lack access to these critical interventions.
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