Ping-Hsin Chen

The Economic Burden of Hospitalizations Associated With Child Abuse and Neglect

OBJECTIVES This study assessed the economic burden of child abuse-related hospitalizations. METHODS We compared inpatient stays coded with a diagnosis of child abuse or neglect with stays of other hospitalized children using the 1999 National Inpatient Sample of the Healthcare Costs and Utilization Project. RESULTS Children whose hospital stays were coded with a diagnosis of abuse or neglect were significantly more likely to have died during hospitalization (4.0% vs 0.5%), have longer stays (8.2 vs 4.0 days), twice the number of diagnoses (6.3 vs 2.8), and double the total charges (19,266 vs 9513 US dollars) than were other hospitalized children. Furthermore, the primary payer was typically Medicaid (66.5% vs 37.0%). CONCLUSION Earlier identification of children at risk for child abuse and neglect might reduce the individual, medical, and societal costs.

Randomized Comparison of 3 Methods to Screen for Domestic Violence in Family Practice

PURPOSE We undertook a study to compare 3 ways of administering brief domestic violence screening questionnaires: self-administered questionnaire, medical staff interview, and physician interview. METHODS We conducted a randomized trial of 3 screening protocols for domestic violence in 4 urban family medicine practices with mostly minority patients. We randomly assigned 523 female patients, aged 18 years or older and currently involved with a partner, to 1 of 3 screening protocols. Each included 2 brief screening tools: HITS and WAST-Short. Outcome measures were domestic violence disclosure, patient and clinician comfort with the screening, and time spent screening. RESULTS Overall prevalence of domestic violence was 14%. Most patients (93.4%) and clinicians (84.5%) were comfortable with the screening questions and method of administering them. Average time spent screening was 4.4 minutes. Disclosure rates, patient and clinician comfort with screening, and time spent screening were similar among the 3 protocols. In addition, WAST-Short was validated in this sample of minority women by comparison with HITS and with the 8-item WAST. CONCLUSIONS Domestic violence is common, and we found that most patients and clinicians are comfortable with domestic violence screening in urban family medicine settings. Patient self-administered domestic violence screening is as effective as clinician interview in terms of disclosure, comfort, and time spent screening.

Intimate Partner Violence and Cancer Screening among Urban Minority Women

Purpose: To evaluate the association of intimate partner violence (IPV) with breast and cervical cancer screening rates. Methods: We conducted retrospective chart audits of 382 adult women at 4 urban family medicine practices. Inclusion criteria were not being pregnant, no cancer history, and having a partner. Victims were defined as those who screened positive on at least one of 2 brief IPV screening tools: the HITS (Hurt, Insult, Threat, Scream) tool or Women Abuse Screening Tool (short). Logistic regression models were used to examine whether nonvictims, victims of emotional abuse, and victims of physical and/or sexual abuse were up to date for mammograms and Papanicolaou smears. Results: Prevalence of IPV was 16.5%. Compared with victims of emotional abuse only, victims of physical and/or sexual abuse aged 40 to 74 were associated with 87% decreased odds of being up to date on Papanicolaou smears (odds ratio, 0.13; 95% CI, 0.02–0.86) and 84% decreased odds of being up to date in mammography (odds ratio, 0.16; 95% CI, 0.03–0.99). There was no difference in Papanicolaou smear rates among female victims and nonvictims younger than 40. Conclusions: Because of the high prevalence of IPV, screening is essential among all women. Clinicians should ensure that victims of physical and/or sexual abuse are screened for cervical cancer and breast cancer, particularly women aged 40 or older. Cancer screening promotion programs are needed for victims of abuse.

Mapping the elder mistreatment iceberg: U.S. hospitalizations with elder abuse and neglect diagnoses

Purpose: This study describes U.S. hospitalizations with diagnostic codes indicating elder mistreatment (EM). Method: Using the 2003 Nationwide Inpatient Sample (NIS) of the Healthcare Costs and Utilization Project (HCUP), inpatient stays coded with diagnoses of adult abuse and/or neglect are compared with stays of other hospitalized adults age 60 and older. Results: Few hospitalizations (< 0.02%) were coded with EM diagnoses in 2003. Compared to other hospitalizations of older adults, patients with EM codes were twice as likely to be women (OR = 2.12, 95% CI = 1.63–2.75), significantly more likely to be emergency department admissions (78.0% vs. 56.8%, p < .0001), and, on average, more likely to have longer stays (7.0 vs. 5.6 days, p = 0.01). Patients with EM codes were also three to four times more likely to be discharged to a facility such as a nursing home rather than “routinely” discharged (i.e., to home or self-care) (OR = 3.66, 95% CI = 2.92–4.59). Elder mistreatment–coded hospitalizations compared to all other hospitalizations had on average lower total charges (

Relation of Domestic Violence to Health Status among Hispanic Women

21,479 vs.

Birth Outcomes in Relation to Intimate Partner Violence

25,127, p < .001), with neglect cases having the highest charges in 2003 (

Training future physicians to screen for and intervene with domestic violence

29,389). Implications: Knowledge about EM is often likened to the “tip of the iceberg.” Our study contributes to “mapping the EM iceberg”; however, findings based on diagnostic codes are limited and should not be used to minimize the problem of EM. With the so-called graying of America, training is needed in recognizing EM along with research to improve our nations response to the mistreatment of our elderly population.

Costs Effectiveness of Domestic Violence Screening in Primary Care Settings: A Comparison of 3 Methods

Little research has addressed the association of domestic violence (DV) with physical and mental health in Hispanic women. We conducted a cross-sectional study with 146 Hispanic women patients in 2002 at an urban family medicine practice. Twenty-one percent of the women were identified as current victims of DV. Two-fifths of victims (41.9%) experienced physical and/or sexual abuse. Approximately two-thirds (64.5%) had depressive symptoms. Poorer mental health was associated with all forms of abuse. Relatively low socioeconomic status and acculturation level may lead to disparities in obtaining services for DV intervention. Culturally appropriate protocols are needed in primary care settings to prevent and intervene among Hispanic women at risk for DV.

Screening for domestic violence in a predominantly Hispanic clinical setting

OBJECTIVES Intimate partner violence (IPV)during pregnancy is a significant public health problem. Approximately 324,000 IPV victimizations occur during pregnancy each year. However, research on the impact of IPV on birth outcomes yields conflicting findings. This study examines the association of IPV with birth outcomes among pregnant women. STUDY DESIGN We used a retrospective cohort study design to analyze data from chart reviews of a random sample of 1542 pregnant women. These women were seen between 2003 and 2009 at an urban university affiliated prenatal clinic and gave birth at the on-site hospital. Victims of IPV were defined as those who scored equal to or higher than 10 on an IPV screening tool: HITS (Hit, Insult, Threaten, and Scream). Three measures were included in birth outcomes. Preterm delivery was defined as gestational age less than 37 weeks. Low birth weight was defined as infants born weighing <2500 g. Neonatal intensive care was measured by prevalence of receiving intensive care. RESULTS The prevalence of IPV was 7.5%. Compared to non-abused women, abused women were more likely to have preterm deliveries (18.3% vs. 10.3%; p = .016). Compared to infants of non-victims, infants of victims were more likely to have low birth weight (21.5% vs. 11.0%; p = .003) and to receive neonatal intensive care (23.4% vs. 7.8%; p = .000). Results from multivariate analyses indicated that victims were more likely to have preterm deliveries than non-victims (OR = 1.72; 95% CI: 1.22-2.95). More infants of victims had low birth weight (OR = 2.03; 95% CI: 1.22-3.39) and received neonatal intensive care than those of non-victims (OR = 4.04; 95% CI: 2.46-6.61). CONCLUSIONS Abused pregnant women had poorer birth outcomes compared to non-abused pregnant women. Healthcare providers should be trained to screen and identify women for IPV, and interventions should be designed to reduce and prevent IPV and thereby improve health outcomes for victims and their children.

Breast and cervical cancer screening in obese minority women.

What problems were addressed? In a recent update, the US Preventive Services Task Force recommended that clinicians screen women of childbearing age (14–46 years) for domestic violence (DV) and provide or refer women who screen positive for intervention. However, few women are asked about DV in the doctor’s office. Barriers to provision of intervention include lack of coordination among providers, no assistance with identifying resources and lack of knowledge about management of DV. What was tried? We developed a new DV clerkship curriculum for fourth-year medical students. This curriculum aims to improve the response to victims of DV in clinical settings and to enhance collaboration among health care professionals and community DV programmes. The 2-week curriculum includes six components: (i) training in DV screening and intervention; (ii) screening for and intervening in DV in clinical settings; (iii) chart reviews of victims; (iv) visiting a local DV shelter; (v) attending DV support groups; and (vi) giving a presentation to fellow medical students. During each rotation, one to two students were trained by the authors, a social worker and attending physicians. Screening was conducted at three clinical settings: obstetrics and gynaecology, family practice and paediatrics. The fouritem screening tool HITS (Hurt, Insulted, Threatened, and Screamed at) was used to identify victims of DV. Victims received an intervention for DV and its associated health problems from a student and an attending physician or social worker. Chart reviews of victims were then conducted to recognise signs of DV. Students visited the local DV shelter and a DV support group to provide health education and to promote health awareness among victims and survivors. Finally, students gave a presentation to their fellow medical students to improve awareness of DV screening and intervention. What lessons were learned? Approximately 20 students are trained each year. Feedback from students indicated that the rotation increased their comfort level in asking patients about DV. Students expressed that they are willing to screen patients for DV in the future. Students also found that victims in the DV shelter were open and receptive to the education provided by health care professionals. Through this clerkship, almost 900 patients were screened for DV. Approximately one-fourth of women (22%) had been exposed to DV and 10% had disabilities. Brief advocacy was provided to 124 women. Advocacy or counselling were conducted according to clients’ needs: 23% had depression, 21% were drug abusers, 26% had drinking problems, 5% were smokers, 12% had a sexually transmitted disease (STD) and 5% had a history of injury. Health education was provided to 105 women at a DV shelter. These weekly 1-hour sessions included topics on child health, immunisation, injury, safety, breast feeding, asthma care, mental health, STDs, cancer screening, insurance, etc. A tailored training programme for future physicians can increase screening for and intervention in DV and providers’ comfort level with screening. A DV clerkship can enhance collaboration among health care professionals and community DV programmes. By identifying women at risk, we may prevent DV and its negative health outcomes.