Exploring the Effects of a Hospital Violence Intervention Program on Services Upon Discharge
*Amir Ebadinejad MD1, *Juan P. Cobar MD1, Jonathan Gates MD1, *David Crump 2, *Ya-Huei Li PhD3, Matthew Lissauer MD1, Jane Keating MD1
1Department of Surgery, Hartford Hospital, Hartford, CT; 2Hospital Violence Intervention Program, Hartford Hospital, Hartford, CT; 3Department of Research Administration, Hartford HealthCare, Hartford, CT
Introduction:
Hospital Violence Intervention Programs (HVIPs) have proven effective in reducing recidivism rates, lowering hospital costs, and enhancing employment and educational opportunities among victims of violence. However, the effects of HVIPs on the utilization of discharge services for patients following penetrating injuries are uncertain. We hypothesized that patients who were seen by our HVIP specialist would have higher rates of participation in in-home nursing services and inpatient and outpatient rehabilitation services upon discharge compared to those who were not seen by our HVIP specialist.
Methods:
We conducted a retrospective study to assess the utilization of discharge services among patients who suffered from gunshot or stab wounds within the first year of HVIP implementation in our hospital between October 2022 and September 2023. The comparisons in outcomes (including inpatient rehabilitation, outpatient rehabilitation, and home health services) between groups (seen vs. not seen by HVIP specialist) were tested with parametric or non-parametric procedures with a two-sided alpha level of 0.05. A multivariate logistic regression was performed to identify the predictors for service utilization, which is the composited inpatient rehabilitation and home health services.
Results:
Among the 192 patients, 62 (32.3%) were seen by the HVIP specialist (HVIP), and 130 (67.7%) were not seen by the HVIP specialist (non-HVIP). The population comprised 21.3% white, 34.0% black, and 39.4% -Hispanic/Latino, showing no significant difference between the groups. The HVIP group was significantly younger (median [M]: 35, interquartile range [IQR]: 26-44 vs. M: 31, IQR: 24-37; p=0.010) with more proportion of gunshot wounds (77.4% vs. 45.4%; p<0.001) compared to the non-HVIP-group. The median injury severity score (ISS) was higher in the HVIP group (M: 4, IQR: 1-9 vs. M: 1, IQR: 1-9; p =0.029). The utilization rate of inpatient rehabilitation was statistically higher in the HVIP group (12.9% vs. 3.1%; p=0.020). The utilization of outpatient rehabilitation (12.9% vs. 10.8%; p=0.664), and home health services (12.9% vs. 6.2%; p=0.114) showed no statistical difference. In the multivariate logistic regression model, hospital admission (odds ratio [OR]: 10.5, 95% confidence interval [CI]: 1.2-91.9; p=0.033), being Hispanic (OR: 3.2, 95%CI: 1.1-9.3; p=0.035), and having a higher ISS (OR: 1.2, 95%CI: 1.1-1.3; p<0.001) were strong predictors of discharge services utilization. HVIP was associated with a higher likelihood of discharge services utilization (OR: 2.5, 95%CI: 0.9-7.1; p=0.078), but because of the wide distribution range, the effect of HIVIP was not statistically significant.
Conclusion:
Our findings underscore the potential of HVIP in improving health resource utilization among Hispanic patients with gunshot or stab injuries. Further studies with larger sample sizes are necessary to validate our findings.
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