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Lumbard DC, West MA, Cich IR, Hassan S, Shankar S, Nygaard RM. Pooled Analysis of Trauma Centers Better Predicts Risk Factors for Firearm Violence Reinjury. J Surg Res 2024; 297:1-8. [PMID: 38401378 DOI: 10.1016/j.jss.2024.01.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 01/22/2024] [Accepted: 01/26/2024] [Indexed: 02/26/2024]
Abstract
INTRODUCTION Many trauma centers use the first firearm injury admission as a reachable moment to mitigate reinjury. Understanding repeat firearm violence can be difficult in metropolitan areas with multiple trauma centers and laws that prohibit sharing private health information across health systems. We hypothesized that risk factors for repeat firearm violence could be better understood using pooled data from two major metropolitan trauma centers. METHODS Two level I trauma center registries were queried (2007-2017) for firearm injury admissions using International Classification of Diseases, Ninth and Tenth Revision (ICD9/10) Ecodes. A pseudo encryption tool allowed sharing of deidentified firearm injury and repeat firearm injury data without disclosing private health information. Factors associated with firearm reinjury admissions including, age, sex, race, payor, injury severity, intent, and discharge, were assessed by multivariable logistic regression. RESULTS We identified 2145 patients with firearm injury admissions, 89 of whom had a subsequent repeat firearm injury admission. Majority of repeat firearm admissions were assaulted (91%), male (97.8%), and non-Hispanic Black (86.5%). 31.5% of repeat firearm injury admissions were admitted to a different trauma center from their initial admission. Independent predictors of repeat firearm injuries were age (adjusted odds ratio [aOR] 0.94, P < 0.001), male sex (aOR 6.18, P = 0.013), non-Hispanic Black race (aOR 5.14, P = 0.007), or discharge against medical advice (aOR 6.64, P=<0.001). CONCLUSIONS Nearly a third of repeat firearm injury admissions would have been missed in the current study without pooled metropolitan trauma center data. The incidence of repeat firearm violence is increasing and those at the highest risk for reinjury need to be targeted for mitigating interventions.
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Affiliation(s)
- Derek C Lumbard
- Department of Surgery, Hennepin Healthcare, Minneapolis, Minnesota.
| | - Michaela A West
- Department of Surgery, North Memorial Health Hospital, Minneapolis, Minnesota
| | - Irena R Cich
- Department of Surgery, Hennepin Healthcare, Minneapolis, Minnesota
| | - Salma Hassan
- Department of Surgery, Hennepin Healthcare, Minneapolis, Minnesota
| | - Sruthi Shankar
- Department of Surgery, Hennepin Healthcare, Minneapolis, Minnesota
| | - Rachel M Nygaard
- Department of Surgery, Hennepin Healthcare, Minneapolis, Minnesota
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2
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Puppalla P, Pick C, Graves J, Harfouche M. Youth Violence Does not Discriminate: Inclusive Violence Prevention Support Services Focused on Counseling and Peer Support are Essential for Youth and Young Adults. Am Surg 2024:31348241244640. [PMID: 38557219 DOI: 10.1177/00031348241244640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
BACKGROUND Violence disproportionately affects individuals of low socioeconomic status, and rates of injury amongst youth and young adults (YYAs) are rising. Little is known about how the social needs of this high-risk subgroup compared to the overall violently injured population. METHODS This is a retrospective review of an intake assessment of violently injured victims admitted to a level I trauma center (Jan 2022-Aug 2023). Data collected include race, age, mechanism of injury, and protective and predisposing factors for violent injury. We compared the risk factors of YYAs (=≤ 24 years) to those of adults (>24) and evaluated rates and types of violence prevention services requested by age group. RESULTS Of 350 individuals surveyed, 94 (27%) were <= 24 years and 256 (73%) were >24 years. Younger patients were less likely to be male (77% vs 86%, P = .03) and experienced more firearm injury (76% vs 51%, P < .001). They reported less alcohol use (20% vs 38%, P < .001), similar rates of mental illness (25% vs 26%, P = .62), less housing instability (5% vs 22%, P < .001), and similar access to government benefits (20% vs 29%, P = .2) compared to the older cohort. Services were requested by 41% of the study population (N = 142); the younger cohort was 2.9 times more likely to request non-financial services (P = .042). DISCUSSION Violently injured youth and young adults (YYAs) experience disproportionately high rates of gun violence. Efforts should be made to prioritize legal, peer support, and mental health services over financial services for this population.
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Affiliation(s)
| | - Carly Pick
- University of Maryland Medical Center, R Adams Cowley Shock Trauma Center, Baltimore, MD, USA
| | - Justin Graves
- University of Maryland Medical Center, R Adams Cowley Shock Trauma Center, Baltimore, MD, USA
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Roden-Foreman JW, Pettigrew M, Edmundson PM, Glenn C, Tibbs B. Safer neighborhoods? Violent crime and trauma volume pre/post targeted police interventions in Dallas, Texas. Injury 2024; 55:111202. [PMID: 37995626 DOI: 10.1016/j.injury.2023.111202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 11/07/2023] [Accepted: 11/12/2023] [Indexed: 11/25/2023]
Abstract
BACKGROUND Project Safe Neighborhoods: Dallas (PSND) is part of a national initiative that partners federal, state, and local stakeholders and law enforcement to reduce violent crime, especially firearm violence, in select communities. The authors' hospital is located centrally in PSND's target areas, and the trauma center's service area fully covers the target areas. This cohort study evaluated PSND's effectiveness by examining if PSND's April 2018 launch was associated with decreases in (1) violent crime or (2) the rate of patients presenting with firearm and assaultive injuries. METHODS Data on violent crime (murder/non-negligent homicide, robbery, and aggravated assault) were obtained from all municipalities in the county for January 2015 - December 2020. Patient volume data were queried from the trauma registry for the same period. Nonlinear spatiotemporal models were used to calculate estimated rates and confidence intervals; derivatives were used to determine periods of significant change. Spatial point pattern tests assessed potential relocation of criminal activity. Given the importance of reducing violent crime, alpha was set at 0.05. RESULTS The target areas' violent crime rate remained higher than the non-target areas' throughout the study period, and target area violent crime non-significantly increased after PSND's launch. Violent crime in the non-target area increased significantly between February 2018 and February 2019. Part of this increase was attributable to a 7-fold increase (odds ratio [95% confidence interval] = 7.32 [2.58, 30.65], p < 0.001) in one police patrol beat just outside of the target areas. After years of decreases, rates of patients presenting with assaultive injuries or firearm injuries began significantly increasing and nearly doubled within two years of PSND. CONCLUSIONS Results suggest PSND was ineffective. Criminal activity in the target area was not reduced relative to its pre-intervention levels or relative to the non-target areas. Offenders may have moved outside the target areas to evade increased scrutiny. Additionally, rates of firearm and assaultive injuries increased. As trusted third parties, trauma centers should consider evaluating local crime and injury prevention programs for effectiveness.
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Affiliation(s)
- Jacob W Roden-Foreman
- Trauma Administration, Texas Health Presbyterian Hospital Dallas, 8200 Walnut Hill Lane, Dallas, TX 75231, USA.
| | - Morgan Pettigrew
- Department of Surgery, Texas Health Presbyterian Hospital Dallas, 8200 Walnut Hill Lane, Dallas, TX 75231, USA
| | - Philip M Edmundson
- Department of Surgery, Texas Health Presbyterian Hospital Dallas, 8200 Walnut Hill Lane, Dallas, TX 75231, USA
| | - Catherine Glenn
- Trauma Administration, Texas Health Presbyterian Hospital Dallas, 8200 Walnut Hill Lane, Dallas, TX 75231, USA
| | - Brian Tibbs
- Department of Surgery, Texas Health Presbyterian Hospital Dallas, 8200 Walnut Hill Lane, Dallas, TX 75231, USA
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Scott JW, Anderson GA, Conatser A, de Souza C, Evans E, Goodwin Z, Jakubus JL, Kelm J, Mekled I, Monahan J, Oh EJ, Oliphant BW, Hemmila MR. Multicenter evaluation of financial toxicity and long-term health outcomes after injury. J Trauma Acute Care Surg 2024; 96:54-61. [PMID: 37867247 DOI: 10.1097/ta.0000000000004161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2023]
Abstract
BACKGROUND Despite the growing awareness of the negative financial impact of traumatic injury on patients' lives, the association between financial toxicity and long-term health-related quality of life (hrQoL) among trauma survivors remains poorly understood. METHODS Patients from nine trauma centers participating in a statewide trauma quality collaborative had responses from longitudinal survey data linked to inpatient trauma registry data. Financial toxicity was defined based on patient-reported survey responses regarding medical debt, work or income loss, nonmedical financial strain, and forgone care due to costs. A financial toxicity score ranging from 0 to 4 was calculated. Health-related quality of life was assessed using the EuroQol 5 Domain tool. Multivariable regression models evaluated the association between financial toxicity and hrQoL outcomes while adjusting for patient demographics, injury severity and inpatient treatment intensity, and health systems variables. RESULTS Among the 403 patients providing 510 completed surveys, rates of individual financial toxicity elements ranged from 21% to 46%, with 65% of patients experiencing at least one element of financial toxicity. Patients with any financial toxicity had worse summary measures of hrQoL and higher rates of problems in all five EuroQol 5 Domain domains ( p < 0.05 for all). Younger age, lower household income, lack of insurance, more comorbidities, discharge to a facility, and air ambulance transportation were independently associated with higher odds of financial toxicity ( p < 0.05 for all). Injury traits and inpatient treatment intensity were not independently associated with financial toxicity. CONCLUSION A majority of trauma survivors in this study experienced some level of financial toxicity, which was independently associated with worse risk-adjusted health outcomes across all hrQoL measures. Risk factors for financial toxicity are not related to injury severity or treatment intensity but rather to sociodemographic variables and measures of prehospital and posthospital health care resource utilization. Targeted interventions and policies are needed to address financial toxicity and ensure optimal recovery for trauma survivors. LEVEL OF EVIDENCE Prognostic and Epidemiological; Level III.
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Affiliation(s)
- John W Scott
- From the Department of Surgery (J.W.S.), Harborview Medical Center, University of Michigan, Ann Arbor, Michigan; Department of Surgery (J.W.S., A.C., C.d.S., Z.G., J.L.J., J.K., I.M., J.M., E.J.O., M.R.H.), Center for Healthcare Outcomes and Policy (J.W.S., E.J.O., B.W.O., M.R.H.), University of Michigan, Ann Arbor, Michigan; Department of Surgery (G.A.A.), Brigham and Women's Hospital, Boston, Massachusetts; University of Michigan Medical School (E.E.); and Department of Orthopedic Surgery (B.W.O.), University of Michigan, Ann Arbor, Michigan
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Schenck CS, Dodington J, Paredes L, Gawel M, Nedd A, Vega P, O’Neill KM. Implementation of an emerging hospital-based violence intervention program: a multimethod study. Trauma Surg Acute Care Open 2023; 8:e001120. [PMID: 38020854 PMCID: PMC10660964 DOI: 10.1136/tsaco-2023-001120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 10/09/2023] [Indexed: 12/01/2023] Open
Abstract
Background Individuals who experience assaultive firearm injury are at elevated risk for violent reinjury and multiple negative physical and psychological health outcomes. Hospital-based violence intervention programs (HVIPs) may improve patient outcomes through intensive, community-based case management. Methods We conducted a multimethod evaluation of an emerging HVIP at a large trauma center using the RE-AIM framework. We assessed recruitment, violent reinjury outcomes, and service provision from 2020 to 2022. Semistructured, qualitative interviews were performed with HVIP participants and program administrators to elicit experiences with HVIP services. Directed content analysis was used to generate and organize codes from the data. We also conducted clinician surveys to assess awareness and referral patterns. Results Of the 319 HVIP-eligible individuals who presented with non-fatal assaultive firearm injury, 39 individuals (12%) were enrolled in the HVIP. Inpatient admission was independently associated with HVIP enrollment (OR 2.6, 95% CI 1.3 to 5.2; p=0.01). Facilitators of Reach included engaging with credible messengers, personal relationships with HVIP program administrators, and encouragement from family to enroll. Fear of disclosure to police was cited as a key barrier to enrollment. For the Effectiveness domain, enrollment was not associated with reinjury (OR 0.70, 95% CI 0.16 to 3.1). Participants identified key areas of focus where needs were not met including housing and mental health. Limited awareness of HVIP services was a barrier to Adoption. Participants described strengths of Implementation, highlighting the deep relationships built between clients and administrators. For the long-term Maintenance of the program, both clinicians and HVIP clients reported that there is a need for HVIP services for individuals who experience violent injury. Conclusions Credible messengers facilitate engagement with potential participants, whereas concerns around police involvement is an important barrier. Inpatient admission provides an opportunity to engage patients and may facilitate recruitment. HVIPs may benefit from increased program intensity. Level of evidence IV.
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Affiliation(s)
| | - James Dodington
- Center for Injury & Violence Prevention, Yale New Haven Hospital, New Haven, Connecticut, USA
- Department of Pediatrics, Yale School of Medicine, New Haven, Connecticut, USA
| | - Lucero Paredes
- Department of Surgery, Maine Medical Center, Portland, Maine, USA
| | - Marcie Gawel
- Center for Injury & Violence Prevention, Yale New Haven Hospital, New Haven, Connecticut, USA
| | - Antwan Nedd
- Center for Injury & Violence Prevention, Yale New Haven Hospital, New Haven, Connecticut, USA
| | - Pepe Vega
- Center for Injury & Violence Prevention, Yale New Haven Hospital, New Haven, Connecticut, USA
| | - Kathleen M O’Neill
- Department of Surgery, Yale School of Medicine, New Haven, Connecticut, USA
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Jang A, Thomas A, Slocum J, Tesorero K, Danna G, Saklecha A, Wafford E, Regan S, Stey AM. The gap between hospital-based violence intervention services and client needs: A systematic review. Surgery 2023; 174:1008-1020. [PMID: 37586893 DOI: 10.1016/j.surg.2023.07.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 06/22/2023] [Accepted: 07/08/2023] [Indexed: 08/18/2023]
Abstract
BACKGROUND Survivors of intentional interpersonal violence face social challenges related to social determinants of health that led to their initial injury. Hospital-based violence intervention programs reduce reinjury. It is unclear how well they meet clients' reported needs. This systematic review aimed to quantify how well hospital-based violence intervention program services addressed clients' reported needs. METHODS Medline, The Cochrane Library, CINAHL Plus with Full Text, and PsycInfo were queried for studies addressing hospital-based violence intervention programs services and intentional injury survivors' needs in the United States. Case reports, reviews, editorials, theses, and studies focusing on pediatric patients, victims of intimate partner violence, or sexual assault were excluded. Data extracted included program structure, hospital-based violence intervention program services, and client needs assessments before and after receiving hospital-based violence intervention program services. RESULTS Of the 3,339 citations identified, 13 articles were selected for inclusion. Hospital-based violence intervention programs clients' most reported needs included mental health (10 studies), employment (7), and education (5) before receiving hospital-based violence intervention programs services. Only 4 studies conducted quantitative client needs assessments before and after receiving hospital-based violence intervention program services. All 4 studies were able to meet at least 50% of each of the clients' reported needs. The success rate depended on the need and program location: success in meeting mental health needs ranged from 65% to 90% of clients. Conversely, time-intensive long-term needs were least met, including employment 60% to 86% of clients, education 47% to 73%, and housing 50% to 71%. CONCLUSION Few hospital-based violence intervention programs studies considered clients' reported needs. Employment, education, and housing must be a stronger focus of hospital-based violence intervention programs.
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Affiliation(s)
- Angie Jang
- Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Arielle Thomas
- Department of Surgery, Medical College of Wisconsin, Milwaukee, WI. https://twitter.com/ac_thomas7
| | - John Slocum
- Feinberg School of Medicine, Northwestern University, Chicago, IL
| | | | - Giovanna Danna
- Chicago Medical School, Rosalind Franklin University, North Chicago, IL
| | - Anjay Saklecha
- Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Eileen Wafford
- Galter Health Sciences Librarian and Learning Center, Feinberg School of Medicine, Northwestern University
| | | | - Anne M Stey
- Feinberg School of Medicine, Northwestern University, Chicago, IL.
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Jay J, Allen K. Curbing the Epidemic of Community Firearm Violence after the Bruen Decision. THE JOURNAL OF LAW, MEDICINE & ETHICS : A JOURNAL OF THE AMERICAN SOCIETY OF LAW, MEDICINE & ETHICS 2023; 51:77-82. [PMID: 37226753 PMCID: PMC10209991 DOI: 10.1017/jme.2023.42] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
The Supreme Court's decision in New York State Rifle & Pistol Association Inc. v. Bruen undermines the ability of cities and states to regulate firearms safety. Nonetheless, we remain hopeful that firearm violence can decline even after the Bruen decision. Several promising public health approaches have gained broader adoption in recent years. This essay examines the key drivers of community firearm violence and reviews promising strategies to reverse those conditions, including community violence intervention (CVI) programs and place-based and structural interventions.
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Affiliation(s)
- Jonathan Jay
- BOSTON UNIVERSITY SCHOOL OF PUBLIC HEALTH, BOSTON, MASSACHUSETTS, USA
| | - Kalice Allen
- BOSTON UNIVERSITY SCHOOL OF PUBLIC HEALTH, BOSTON, MASSACHUSETTS, USA
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Mueller KL, Lovelady NN, Ranney ML. Firearm injuries and death: A United States epidemic with public health solutions. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001913. [PMID: 37224135 PMCID: PMC10208504 DOI: 10.1371/journal.pgph.0001913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Affiliation(s)
- Kristen L Mueller
- Department of Emergency Medicine, Washington University in St. Louis School of Medicine, St. Louis, MO, United States of America
| | - Nakita N Lovelady
- Department of Health Behavior and Health Education, College of Public Health, University of Arkansas for Medical Sciences, Little Rock, AR, United States of America
| | - Megan L Ranney
- Department of Emergency Medicine, Alpert Medical School, Brown University, Providence RI, United States of America
- Department of Behavioral and Social Science, School of Public Health, Brown University, Providence, RI, United States of America
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Mueller KL, Chapman-Kramer K, Cooper BP, Kaser T, Mancini M, Moran V, Vogel M, Foraker RE, Anwuri V. A Regional Approach to Hospital-Based Violence Intervention Programs Through LOV. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2023; 29:306-316. [PMID: 36961541 DOI: 10.1097/phh.0000000000001716] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/25/2023]
Abstract
CONTEXT Community violence is an underaddressed public health threat. Hospital-based violence intervention programs (HVIPs) have been used to address the root causes of violence and prevent reinjury. OBJECTIVE In this article, we describe the methodology of the St Louis Region-wide HVIP, Life Outside Violence (LOV) program, and provide preliminary process outcomes. DESIGN Life Outside Violence mentors intervene following a violent injury to decrease risk of subsequent victimization and achieve goals unique to each participant by providing therapeutic counseling and case management services to patients and their families. PARTICIPANTS AND SETTING Eligible patients are victims of violent injury between the ages of 8 and 24 years, who are residents of St Louis, Missouri, and present for care at a LOV partner adult or pediatric level I trauma hospital. INTERVENTION Enrolled participants receive program services for 6 to 12 months and complete an individual treatment plan. MAIN OUTCOME MEASURES In this article, we report LOV operational methodology, as well as process metrics, including program enrollment, graduation, and qualitative data on program implementation. RESULTS From August 15, 2018, through April 30, 2022, 1750 LOV-eligible violently injured patients presented to a partner hospital, 349 were approached for program enrollment, and 206 consented to enroll in the program. During this pilot phase, 91 participants graduated from the LOV program and have process output data available for analysis. CONCLUSIONS Life Outside Violence has been implemented into clinical practice as the first HVIP to influence across an entire region through partnership with multiple university and hospital systems. It is our hope that methods shared in this article will serve as a primer for organizations hoping to implement and expand HVIPs to interrupt community violence at the regional level.
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Affiliation(s)
- Kristen L Mueller
- Department of Emergency Medicine, Washington University in St Louis School of Medicine, St Louis, Missouri (Dr Mueller); Institute for Public Health, Washington University in St Louis School of Medicine, St Louis, Missouri (Mss Chapman-Kramer, Kaser, and Anwuri, Mr Cooper, and Dr Foraker); Saint Louis University School of Social Work, St Louis, Missouri (Dr Mancini); Trudy Busch Valentine School of Nursing, Saint Louis University, St Louis, Missouri (Dr Moran); and School of Criminal Justice, University at Albany, Albany, New York (Dr Vogel)
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Hullenaar KL, Rivara FP, Wang J, Zatzick DF. Exploring Collaborative Care Effects on the Mental and Physical Health of Patients With and Without Violent Victimization Histories. JOURNAL OF INTERPERSONAL VIOLENCE 2023; 38:6865-6887. [PMID: 36458828 DOI: 10.1177/08862605221138655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
Collaborative care is a multicomponent intervention delivered by frontline social work, nursing, and physician providers to address patients' physical, emotional, and social needs. We argued that collaborative care may particularly benefit patients with a violent victimization history because it practices three principles of trauma-informed care: patient-provider collaboration, preventing repeat trauma in clinical and community settings, and delivering comprehensive mental and physical healthcare. We conducted an exploratory secondary data analysis of a collaborative care randomized clinical trial involving patients who presented with traumatic physical injury at a Level I trauma center in Washington state between 2006 and 2009. We used random-effect linear regression models to estimate how histories of multiple violent traumas moderated the effects of the collaborative care intervention on Short Form-36 Mental Component Summary (MCS) and Physical Component Summary (PCS) T-scores over time. Collaborative care significantly improved follow-up MCS scores among patients who experienced three to four types of violent victimization in their lifetime. Additionally, intervention effects on MCS scores at the 3- and 6-month follow-up were clinically stronger for patients who reported three to four types of violent victimization (3-month = 7.5, 95% confidence level [CI] = 5.1 to 18.7; 6-month = 11.9, 95% CI = 5.1 to 18.7) than those without a history of violent victimization (3-month = 0.8, 95% CI = -5.1, 6.6; 6-month = 5.6, -2.4 to 13.5). We did not find that intervention effects on PCS scores differed between these groups at any wave. Collaborative care may be a promising approach to delivering trauma-informed mental healthcare to patients with histories of multiple types of violent victimization.
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Affiliation(s)
| | | | - Jin Wang
- University of Washington, Seattle, USA
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11
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Bernardin ME, Spectorsky K, Gu H, Fairfax C, Cutler K. Child Firearm Injury Circumstances and Associations With Violence Intervention Program Enrollment. J Surg Res 2023; 285:67-75. [PMID: 36652770 DOI: 10.1016/j.jss.2022.12.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 12/07/2022] [Accepted: 12/25/2022] [Indexed: 01/18/2023]
Abstract
INTRODUCTION Pediatric firearm injuries are the leading cause of death among American children. While assault is the most commonly cited cause, few studies have investigated circumstances surrounding such injuries. Violence intervention programs (VIPs) have been utilized to combat firearm violence, though a similar lack of knowledge exists regarding possible associations between firearm injury circumstances and youth VIP enrollment. METHODS This cross-sectional study included children aged 6-17 y who presented to an urban level 1 pediatric trauma center with firearm injuries from 2014 to 2017. Victim demographics and enrollment in a VIP were obtained from medical records, as well as circumstances surrounding the injuries based on account of the victim, victim's family/friends, and/or police present at the hospital. Circumstances included location of the shooting, if the shooter was known to the victim, and if the shooting was confirmed by the victim or their contacts to have been accidental or an intentional assault. Medical record numbers were used to locate victims in our trauma registry in order to obtain their assigned international classification of disease codes. Wilcox-rank sum, Pearson's chi-squared and Fisher's exact tests were used to detect associations between demographics, VIP enrollment, and shooting circumstances. RESULTS 156 victims of firearm injury were described, including primarily Black adolescent males. 72% of victims were shot outdoors by an unknown shooter, the motivation of which was unknown in 93% of cases. 36% of these shootings were "drive-by". The majority of victims received international classification of disease codes for assault, though shootings that were confirmed by the victim to have been intentional assaults were relatively uncommon (13.4%). Most children lived in the same zip code in which they were shot (71%), and three particular zip codes accounted for 40% of shootings. 26% of victims chose to enroll in the VIP, and those that were victims of confirmed assaults (odds ratio 3.5) as well as those admitted to the hospital (odds ratio 2.4) were significantly more likely to enroll. CONCLUSIONS Based on victim account, children living in an urban setting are more frequently victims of unclearly motivated, outdoor neighborhood shootings rather than intentional assaults. More accurate understanding of the causes of pediatric firearm injuries should inform both recruitment into VIPs, as well as a balancing of VIPs with community-level interventions to address firearm violence.
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Affiliation(s)
- Mary Elizabeth Bernardin
- Department of Emergency Medicine, University of Missouri School of Medicine, Division of Pediatric Emergency Medicine, Columbia, Missouri; Department of Pediatrics, Washington University School of Medicine, Division of Pediatric Emergency Medicine, St. Louis, Missouri.
| | - Kathryn Spectorsky
- Department of Pediatrics, Washington University School of Medicine, Division of Pediatric Emergency Medicine, St. Louis, Missouri
| | - Hongjie Gu
- Washington University School of Medicine, Division of Biostatistics, St. Louis, Missouri
| | - Connor Fairfax
- Trauma Services, St. Louis Children's Hospital, St. Louis, Missouri
| | - Keven Cutler
- Department of Emergency Medicine, University of Missouri School of Medicine, Division of Pediatric Emergency Medicine, Columbia, Missouri
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12
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Voith LA, Russell KN, Lee H, Atwell MS, McKinney SJ, Thomas T, Barksdale EM. Using grounded theory to develop a theory of change for a violence intervention program. EVALUATION AND PROGRAM PLANNING 2023; 99:102303. [PMID: 37229924 DOI: 10.1016/j.evalprogplan.2023.102303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 03/30/2023] [Accepted: 04/29/2023] [Indexed: 05/27/2023]
Abstract
Hospital-based violence intervention programs (HVIP) are critical to interrupting the cycle of violence. These interventions are considered "complex" in that they have many mechanisms of change and related outcomes. Few HVIPs clearly identify the underlying mechanisms of intervention and explicitly link those with key outcomes however, limiting the field's ability to know what works best and for whom. To develop a program theory of change for these "complex interventions," a non-linear, robust methodology that is grounded in the lived experience of those delivering and receiving services is needed. To aid researchers, evaluators, students, and program developers, we describe the use of Grounded Theory as a methodology to enhance the development of complex interventions, illuminating a non-linear approach that engages key stakeholders. To illustrate application, we describe a case example of The Antifragility Initiative, a HVIP in Cleveland, Ohio. The development of the program theory of change was conducted in four phases: (1) review of existing program documents, (2) semi-structured interviews with program developers (n = 6), (3) a focus group with program stakeholders (n = 8), and (4) interviews with caregivers and youth (n = 8). Each phase informed the next and culminated in a theoretical narrative and visual model of the Antifragility Initiative. Together, the theoretical narrative and visual model identify the underlying mechanisms that can promote change by the program.
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Affiliation(s)
- Laura A Voith
- Jack, Joseph, and Morton Mandel School of Applied Social Sciences Case Western Reserve University, United States; Center on Trauma and Adversity, United States.
| | - Katie N Russell
- Jack, Joseph, and Morton Mandel School of Applied Social Sciences Case Western Reserve University, United States
| | - Hyunjune Lee
- Jack, Joseph, and Morton Mandel School of Applied Social Sciences Case Western Reserve University, United States
| | - Meghan Salas Atwell
- Jack, Joseph, and Morton Mandel School of Applied Social Sciences Case Western Reserve University, United States; Center on Urban Poverty and Community Development, United States
| | - Sherise J McKinney
- Jack, Joseph, and Morton Mandel School of Applied Social Sciences Case Western Reserve University, United States; National Initiative on Mixed-Income Communities, United States
| | - Tito Thomas
- Case Western Reserve University School of Medicine, United States
| | - Edward M Barksdale
- Rainbow Babies and Children's Hospital/University Hospitals, United States; Case Western Reserve University School of Medicine, United States
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O'Neill KM, Dodington J, Gawel M, Borrup K, Shapiro DS, Gates J, Gregg S, Becher RD. The effect of the COVID-19 pandemic on community violence in Connecticut. Am J Surg 2023; 225:775-780. [PMID: 36253316 PMCID: PMC9540704 DOI: 10.1016/j.amjsurg.2022.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 10/02/2022] [Accepted: 10/05/2022] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Natural disasters may lead to increases in community violence due to broad social disruption, economic hardship, and large-scale morbidity and mortality. The effect of the COVID-19 pandemic on community violence is unknown. METHODS Using trauma registry data on all violence-related patient presentations in Connecticut from 2018 to 2021, we compared the pattern of violence-related trauma from pre-COVID and COVID pandemic using an interrupted time series linear regression model. RESULTS There was a 55% increase in violence-related trauma in the COVID period compared with the pre-COVID period (IRR: 1.55; 95%CI: 1.34-1.80; p-value<0.001) driven largely by penetrating injuries. This increase disproportionately impacted Black/Latinx communities (IRR: 1.61; 95%CI: 1.36-1.90; p-value<0.001). CONCLUSION Violence-related trauma increased during the COVID-19 pandemic. Increased community violence is a significant and underappreciated negative health and social consequence of the COVID-19 pandemic, and one that excessively burdens communities already at increased risk from systemic health and social inequities.
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Affiliation(s)
- Kathleen M O'Neill
- Division of General Surgery, Trauma, and Surgical Critical Care, Yale School of Medicine, Department of Surgery, New Haven, CT, 06520, USA; Investigative Medicine Program, Yale School of Medicine, Yale Graduate School of Arts and Sciences, New Haven, CT, 06510, USA.
| | - James Dodington
- Department of Pediatrics, Yale School of Medicine, New Haven, CT, 06510, USA; Violence Intervention Program, Yale New Haven Hospital, USA.
| | - Marcie Gawel
- Violence Intervention Program, Yale New Haven Hospital, USA.
| | - Kevin Borrup
- Injury Prevention Center, Connecticut Children's Medical Center, Hartford, CT, 06106, USA; Department of Pediatrics, University of Connecticut School of Medicine, Farmington, CT, 06032, USA.
| | - David S Shapiro
- Department of Surgery, Saint Francis Hospital & Medical Center, USA; Associate Professor of Surgery University of Connecticut School of Medicine & Frank L. Netter Schools of Medicine, USA.
| | - Jonathan Gates
- Department of Surgery, Hartford Healthcare Hartford Hospital, USA.
| | - Shea Gregg
- Trauma, Burns and Surgical Critical Care, Bridgeport Hospital, USA.
| | - Robert D Becher
- Division of General Surgery, Trauma, and Surgical Critical Care, Yale School of Medicine, Department of Surgery, New Haven, CT, 06520, USA.
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Reitz ACW, Hawk SR, Schwimmer HD, Hanna T, Payne DES. Utilizing a combined hospital and criminal justice database to identify risk factors for repeat firearm injury or violent-crime arrest among firearm victims. MEDICINE, SCIENCE, AND THE LAW 2023; 63:93-104. [PMID: 35726447 DOI: 10.1177/00258024221103695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Introduction: Identifying firearm victims with the greatest risk of repeat-firearm exposure and offering interventions has the potential to disrupt recurrent violence. This study explored risk factors associated with repeat violence among survivors of intentional firearm injury in a unique clinical and criminal justice (CJ) dataset. Methods: This study analyzed a retrospective cohort (n = 4058) of persons injured by nonfatal intentional firearm violence from 2013 to 2016 in one metropolitan area. Data were collected from a single level I trauma center, city police records, and state CJ databases from 1948 to 2019. The primary outcome of interest was another firearm injury or violent-crime arrest (defined as a violent or firearm felony offense). Results: Among 4058 nonfatal intentional firearm victims, 1202 (29.6%) individuals had a repeat-firearm injury or violent-crime arrest. In a bivariate analysis, history of mental, physical, and/or emotional abuse (odds ratio [OR], 1.62; 95% confidence interval [CI], 1.40-1.86), mental health diagnosis (OR, 1.88; 95% CI, 1.51-2.35), or illegal substance use (OR, 2.87; 95% CI, 2.48-3.32) was associated with increased risk of repeat-firearm injury or violent-crime arrest. Prior felony arrest (OR, 3.68; 95% CI, 3.19-4.24), prior incarceration (OR, 3.72; 95% CI, 3.04-4.56), prior firearm charge (OR, 4.06; 95% CI, 3.33-4.96), and suspected gang membership (OR, 8.69; 95% CI, 6.14-12.32) demonstrated the greatest association with significant repeat violence. Conclusions: Thirty percent of those who experienced an intentional firearm injury were found to have a repeat-firearm injury or violent-crime arrest multi-disciplinary interventions that address the complex needs of a CJ-involved population are needed to mitigate significant repeat violence.
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Affiliation(s)
- Alexandra C W Reitz
- Department of Surgery, 12239Emory University School of Medicine, Atlanta, GA, USA
| | | | | | - Tarek Hanna
- Department of Radiology and Imaging Sciences, 12239Emory University School of Medicine, Atlanta, GA, USA
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Shayan M, Lew D, Mancini M, Foraker RE, Doering M, Mueller KL. A systematic review of recurrent firearm injury rates in the United States. Prev Med 2023; 168:107443. [PMID: 36740145 DOI: 10.1016/j.ypmed.2023.107443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 01/08/2023] [Accepted: 01/31/2023] [Indexed: 02/05/2023]
Abstract
OBJECTIVES To conduct a systematic review of methodologies, data sources, and best practices for identifying, calculating, and reporting recurrent firearm injury rates in the United States. METHODS In accordance with PRISMA guidelines, we searched seven electronic databases on December 16, 2021, for peer-reviewed articles that calculated recurrent firearm injury in generalizable populations. Two reviewers independently assessed the risk of bias, screened the studies, extracted data, and a third resolved conflicts. FINDINGS Of the 918 unique articles identified, 14 met our inclusion criteria and reported recurrent firearm injury rates from 1% to 9.5%. We observed heterogeneity in study methodologies, including data sources utilized, identification of subsequent injury, follow-up times, and the types of firearm injuries studied. Data sources ranged from single-site hospital medical records to comprehensive statewide records comprising medical, law enforcement, and social security death index data. Some studies applied machine learning to electronic health records to differentiate subsequent new firearm injuries from the index injury, while others classified all repeat firearm-related hospital admissions after variably defined cut-off times as a new injury. Some studies required a minimum follow-up observation period after the index injury while others did not. Four studies conducted survival analyses, albeit using different methodologies. CONCLUSIONS Variability in both the data sources and methods used to evaluate and report recurrent firearm injury limits individual study generalizability of individual and societal factors that influence recurrent firearm injury. Our systematic review highlights the need for development, dissemination, and implementation of standard practices for calculating and reporting recurrent firearm injury.
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Affiliation(s)
- Muhammad Shayan
- Cordell Institute for Policy in Medicine & Law, Washington University in St. Louis, United States.
| | - Daphne Lew
- Division of Biostatistics, Washington University in St. Louis, United States.
| | - Michael Mancini
- College for Public Health and Social Justice, Saint Louis University, United States.
| | - Randi E Foraker
- Division of General Medical Sciences, School of Medicine, Washington University in St. Louis, United States.
| | - Michelle Doering
- Bernard Becker Medical Library, Washington University in St. Louis, United States
| | - Kristen L Mueller
- Department of Emergency Medicine, School of Medicine, Washington University in St. Louis, United States.
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16
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Setting up violence intervention specialists for success: Bridging the gap between concept and practice in hospital-based violence intervention programs. Am J Surg 2023:S0002-9610(23)00091-0. [PMID: 36870790 DOI: 10.1016/j.amjsurg.2023.02.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 02/23/2023] [Accepted: 02/24/2023] [Indexed: 03/04/2023]
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17
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Beyond Recidivism: Hospital-Based Violence Intervention and Early Health and Social Outcomes. J Am Coll Surg 2022; 235:927-939. [PMID: 36102509 DOI: 10.1097/xcs.0000000000000409] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Hospital-based violence intervention programs (HVIPs) are aimed at decreasing recurrent injury and improving the social determinants of health. We hypothesized that the HVIP intervention should be evaluated by how well it can address the immediate health and social needs of patients after injury. Our study sought to describe the experience of our nascent HVIP. STUDY DESIGN Case management records of patients treated by the HVIP of a level 1 trauma center from July 1, 2017 to October 1, 2020 were reviewed. Inclusion criteria were as follows: age between 18 and 60 with injury mechanisms that resulted from intentional violence. Patient-stated goals and social worker designation of patient services provided were analyzed. A subset of HVIP patients who completed the three planned study visit surveys at discharge and 1 and 3 months were compared with a cohort of violently injured patients to whom HVIP services were not available. Participants in both groups were asked to complete a battery of validated surveys to assess social outcomes and post-traumatic stress disorder (PTSD). Repeated-measures ANOVA was used to compare the two groups. RESULTS Two hundred and ninety-five patients met the inclusion criteria. One hundred and forty-six patients (49%) achieved their stated goals within 6 months of hospital discharge. Sixteen patients who achieved their stated goals disengaged from the program. Engagement in the HVIP resulted in significantly less PTSD at the time of hospital discharge. HVIP patients also experienced higher positive affect at hospital discharge, as described in the Positive and Negative Affect Schedule. HVIP participants were significantly more likely to achieve early positive health outcomes, such as completion of victim of crime compensation and return to school. CONCLUSIONS Our HVIP successfully achieved patient-stated short-term health and social goals in nearly half of all enrollees, indicating that HVIP patients are more likely to improve their social determinants of health than non-HVIP patients. Short-term health and social outcomes were improved in HVIP patients compared with non-HVIP patients, indicating increased engagement with the healthcare system. We suggest that these outcomes should replace recidivism as a metric for the efficacy of HVIP programs.
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Holler, MPH E, Ortiz, MD D, Mohanty, MD, MS S, Meagher, MD, MPH AD, Boustani, MD, MPH M, Zarzaur, MD, MPH BL, Simons, MD CJ. Violent injury prevention does not equal to violent crime prevention: an analysis of violence intervention program efficacy using propensity score methods. Trauma Surg Acute Care Open 2022; 7:e000905. [PMID: 36267559 PMCID: PMC9577934 DOI: 10.1136/tsaco-2022-000905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 08/29/2022] [Indexed: 11/03/2022] Open
Abstract
Objective The purpose of this study was to determine if exposure to Prescription for Hope (RxH), a hospital-based violence intervention program (HVIP), is associated with reduced violent reinjury and new convictions for violent crime in the 2-year period after index hospitalization for a violent injury. Methods This was a retrospective cohort study analyzing patients from two level I trauma centers in Indianapolis, Indiana. RxH participants (n=260) enrolled between January 1, 2015 and December 31, 2018 and who had trauma registry data were included. RxH eligibility criteria: admitted for a violent injury (excluding sexual violence), at least 15 years of age, live in Marion County, Indiana, and stay in the hospital for at least 24 hours. RxH exclusion criteria: heavy active substance use, acute psychosis, dementia, severe traumatic brain injury, intentional self-harm, and incarceration. All patients admitted to IU Health Methodist Hospital, a nearby level I trauma center, for an assault, stabbing, or gunshot wound during the same period and met the RxH eligibility criteria were included as a comparison group (n=732). Doubly adjusted logistic regression with inverse probability of treatment weighting was used to estimate the average treatment effect of RxH participation on violent reinjury and new convictions for violent crime. Results Data from 992 patients were analyzed. RxH was significantly associated with reduced odds of violent reinjury (OR=0.35, 95% CI 0.20 to 0.59) and increased odds of conviction for a violent crime (OR=2.43, 95% CI 1.64 to 3.61). Conclusion RxH was associated with decreased odds of violent reinjury but increased odds of new conviction for a violent crime. Our results highlight the importance of robust, routine evaluation of HVIP efficacy and recommend inclusion of other outcomes in addition to violent reinjury when evaluating program success. High-quality randomized controlled trials are needed to further investigate the impact of HVIPs on a variety of outcomes. Level of evidence IV: retrospective study with more than one negative criterion ((1) limited control of confounding and (2) heterogeneous populations).
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Affiliation(s)
- Emma Holler, MPH
- Department of Epidemiology and Biostatistics, Indiana University, Bloomington, Indiana, USA
| | - Damaris Ortiz, MD
- Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana, USA,Eskenazi Health, Eskenazi Health Hospital, Indianapolis, Indiana, USA
| | - Sanjay Mohanty, MD, MS
- Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana, USA,Methodist Hospital, Indiana University Health, Indianapolis, Indiana, USA
| | - Ashley D Meagher, MD, MPH
- Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana, USA,Methodist Hospital, Indiana University Health, Indianapolis, Indiana, USA
| | | | - Ben L Zarzaur, MD, MPH
- Surgery, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Clark J Simons, MD
- Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana, USA,Eskenazi Health, Eskenazi Health Hospital, Indianapolis, Indiana, USA
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19
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Harfouche MN, Walton EC, Richardson JB, Scalea TM. Implementation of an Outpatient Violence Intervention Program to Increase Service Uptake. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2022; 24:535-540. [PMID: 36006598 PMCID: PMC9403958 DOI: 10.1007/s11121-022-01428-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/16/2022] [Indexed: 11/27/2022]
Abstract
Challenges in participant recruitment and retention limit the effectiveness of hospital-based violence intervention programs (HVIPs). This study aimed to determine if an outpatient violence intervention program (VIP) could be integrated into a trauma clinic and increase uptake of violence prevention services. Patients previously hospitalized for intent-to-harm being seen for outpatient follow-up were eligible. VIP counselors met with participants during their clinic visit, administered the survey, and offered violence prevention services (April to June 2019). Patients were followed for 6 months to assess involvement. The primary outcome of interest was long-term participation in the VIP, defined as uptake of services at 6 months, in comparison to inpatient recruitment. Out of 76 patients, 34 (44.7%) did not appear for their appointment. The remainder (n = 42) were offered participation in the study, of which 32 (76.2%) completed the survey. From the group offered VIP services, 57.1% expressed interest, and 5 (20.8%) ultimately took part yielding an overall participation rate of 11.9% at 6 months. The inpatient recruitment rate in 2019 was 2.4%. An outpatient VIP program can be integrated into a clinic setting but suffers from the same challenges faced by inpatient programs resulting in low rates of long-term participation in services. Although a high proportion of participants reported interest, actual engagement at 6 months was low. Reasons behind low participation in VIP services must be investigated.
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Affiliation(s)
- Melike N Harfouche
- R Adams Cowley Shock Trauma Center, University of Maryland Medical Center, Baltimore, MD, 21201, USA.
| | - Erin C Walton
- R Adams Cowley Shock Trauma Center, University of Maryland Medical Center, Baltimore, MD, 21201, USA
- Center for Injury Prevention and Policy, University of Maryland Medical Center, Baltimore, MD, 21201, USA
| | - Joseph B Richardson
- University of Maryland, College Park, USA
- Department of African American Studies, University of Maryland, College Park, MD, 20742, USA
| | - Thomas M Scalea
- R Adams Cowley Shock Trauma Center, University of Maryland Medical Center, Baltimore, MD, 21201, USA
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20
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Hiranniramol K, Moran V, Israel H, Flood R. Characteristics of Adult Patients for Violence-Related Injuries Presenting to a Level 1 Trauma Center in Midwest United States. Hosp Top 2022; 101:352-359. [PMID: 35446753 DOI: 10.1080/00185868.2022.2065398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Hospital violence intervention programs (HVIPs) have recently been initiated in trauma centers across the United States. However, violence-related injuries have unique factors and issues that should be addressed in the health care provided in emergency departments. PURPOSE This study aimed to characterize the patient population presenting at a level 1 ACS verified trauma center, with a chief complaint of violent trauma, and identify characteristics of patients most at risk for violence-related trauma. METHODS The cross-sectional retrospective study examined patients' electronic health records, at least 18 years, with a diagnosis of blunt or penetrating injury treated by the emergency and trauma team at level 1 ACS verified trauma center in the Midwest. RESULTS Assault injuries accounted for most of the mechanisms that required treatment at the hospital and disposed to home. Nearly 80% of the population had no documentation of the relationship of the assailant. The average age of the patients was 33 years and black males. Eleven patients were treated in the emergency department twice for a trauma-related injury during the six-month data collection. CONCLUSION Injuries from violence require comprehensive care from various healthcare disciplines, similar to managing acute and chronic illnesses. The American College of Surgeons (ACS) guidelines support the development of an HVIP to identify risk factors and treatment plans for any patient exposed to violence. This research demonstrates that HVIPs should provide standardized screening and follow-up care while in the emergency department or immediately following the hospital to reduce the cyclical events.
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Affiliation(s)
| | - Vicki Moran
- Saint Louis University, St. Louis, MO, USA
- Trauma Research, SSM Health Saint Louis University, St. Louis, MO, USA
| | - Heidi Israel
- Orthopaedic Surgery, Saint Louis University, St. Louis, MO, USA
| | - Robert Flood
- Pediatrics - Emergency Medicine, SSM Health Cardinal Glennon Children's Hospital, Saint Louis University, St. Louis, MO, USA
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21
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Magee LA, Lucas B, Fortenberry JD. Changing epidemiology of firearm injury: a cohort study of non-fatal firearm victimisation before and during the COVID-19 pandemic, Indianapolis, Indiana. BMJ Open 2022; 12:e059315. [PMID: 35321899 PMCID: PMC8943482 DOI: 10.1136/bmjopen-2021-059315] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 02/25/2022] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE To examine victimisation rates, geographic patterns and neighbourhood characteristics associated with non-fatal firearm injury rates before and during the COVID-19 pandemic. DESIGN A retrospective cohort study. SETTING City of Indianapolis, Indiana, USA, 1 January 2017-30 June 2021. PARTICIPANTS Intentional non-fatal firearm injury victims from Indianapolis Metropolitan Police Department records. The study included information on 2578 non-fatal firearm injury victims between ages 0 and 77 years. Of these victims, 82.5% were male and 77.4% were black. PRIMARY AND SECONDARY OUTCOME MEASURES Rates of non-fatal firearm injuries per 100 000 population by victim age, race, sex and incident motive. Prepandemic and peripandemic non-fatal firearm injury rates. RESULTS Non-fatal shooting rates increased 8.60%, from 57.0 per 100 000 person-years in prepandemic years to 65.6 per 100 000 person-years during the pandemic (p<0.001). Rates of female victims (15.2 vs 23.8 per 100,000; p<0.001) and older victims (91.3 vs 120.4 per 100,000; p<0.001) increased significantly during the pandemic compared with the prepandemic period. Neighbourhoods with higher levels of structural disadvantage (IRR: 1.157, 95% CI 1.012 to 1.324) and prepandemic firearm injury rates (IRR: 1.001, 95% CI 1.001 to 1.002) was positively associated with higher rates of non-fatal firearm injuries during the pandemic, adjusting for neighbourhood characteristics. CONCLUSIONS Non-fatal firearm injuries increased significantly during the COVID-19 pandemic, particularly among female and older victims. Efforts are needed to expand and rethink current firearm prevention efforts that both address the diversification of victimisation and the larger societal trauma of firearm violence.
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Affiliation(s)
- Lauren A Magee
- O'Neill School of Public and Environmental Affairs, Indiana University Purdue University Indianapolis, Indianapolis, Indiana, USA
| | - Bailee Lucas
- O'Neill School of Public and Environmental Affairs, Indiana University Purdue University Indianapolis, Indianapolis, Indiana, USA
| | - James Dennis Fortenberry
- Department of Adolescent Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
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22
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Bulger E, Johnson P, Parker L, Moloney KE, Roberts MK, Vaziri N, Seo S, Nehra D, Thomas P, Zatzick D. Nationwide Survey of Trauma Center Screening and Intervention Practices for Posttraumatic Stress Disorder, Firearm Violence, Mental Health, and Substance Use Disorders. J Am Coll Surg 2022; 234:274-287. [PMID: 35213489 PMCID: PMC10234338 DOI: 10.1097/xcs.0000000000000064] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Posttraumatic stress disorder (PTSD) symptoms, firearm violence events, alcohol and drug use problems, and major depression and suicidal ideation are endemic among patients admitted to US trauma centers. Despite increasing policy importance, the current availability of screening and intervention services for this constellation of conditions in US trauma centers is unknown. STUDY DESIGN Trauma program staff at all Level I and Level II trauma centers in the US. (N = 627) were contacted to complete a survey describing screening and intervention procedures for alcohol and drug use problems, PTSD symptoms, depression and suicidality, and firearm violence. Additional questions asked trauma centers about the delivery of peer interventions and information technology capacity for screening and intervention procedures. RESULTS Fifty-one percent of trauma centers (n = 322) responded to the survey. More than 95% of responding sites endorsed routinely screening and/or intervening for alcohol use problems. Routine services addressing PTSD were less common, with 28% of centers reporting routine screening. More than 50% of sites that screened for PTSD used previously established trauma center alcohol use services. Programmatic screening and intervention for firearm injury sequelae was occurring at 30% of sites. CONCLUSION Alcohol screening and intervention is occurring frequently at US trauma centers and appears to be responsive to American College of Surgeons Committee on Trauma verification requirements. Routine screening and intervention services for PTSD and firearm injury were occurring less frequently. Regular national surveys may be a key element of tracking progress in national mental health and substance use screening, intervention, and referral policy.
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Affiliation(s)
- Eileen Bulger
- Department of Surgery, University of Washington School of Medicine, Seattle, WA
| | - Peyton Johnson
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA
| | - Lea Parker
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA
- Department of Psychology, Drexel University College of Arts and Sciences, Philadelphia, PA
| | - Kathleen E Moloney
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA
| | - Michelle K Roberts
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA
- Department of Rehabilitation Medicine, University of Washington School of Medicine, Seattle, WA
- Department of Anthropology, University of Kentucky College of Arts and Sciences, Lexington, KY
| | - Natalie Vaziri
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA
| | - Sara Seo
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA
| | - Deepika Nehra
- Department of Surgery, University of Washington School of Medicine, Seattle, WA
| | - Peter Thomas
- Powers Pyles Sutter & Verville PC, Washington, DC
| | - Douglas Zatzick
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA
- Harborview Injury Prevention and Research Center, University of Washington School of Medicine, Seattle, WA
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23
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O'Neill KM, Jean RA, Dodington J, Davis K, Becher RD. Evaluation of Firearm-related Reinjury in Connecticut: An Opportunity for Gun Violence Prevention. J Surg Res 2022; 274:23-30. [PMID: 35121547 DOI: 10.1016/j.jss.2021.12.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 11/01/2021] [Accepted: 12/15/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND The regional extent of the risk of repeat firearm-related injury (FRI) and homicide mortality for victims of firearm injury in Connecticut is unknown. In this study, we evaluate the risk of repeat firearm injury in survivors of firearm violence in Connecticut. METHODS Using medical record data from the Yale New Haven Health (YNHH) system and data from the Connecticut Office of the Chief Medical Examiner, we conducted a cohort study of patients with an FRI in 2014 to determine their risk of a repeat firearm injury or mortality from homicide in the ensuing 5 years compared with nonviolence-related trauma patient controls. RESULTS We identified 94 patients with an FRI in the YNHH system from 2014 who survived to discharge. Of these patients, 8.5% (8 of 94) had a repeat FRI and 2% (2 of 94) died from homicide within the next 5 years. Compared with nonviolence-related trauma patients from 2014 (n = 2001), those with an FRI had 12 times the odds of a repeat firearm injury (odds ratio: 12.0, P = 0.047) in the next 5 years after adjustment for relevant covariates. CONCLUSIONS Of the patients presenting with an initial FRI in the YNHH system, one in twelve will experience another firearm injury within the next 5 years. These data indicate that firearm-related reinjury is common in Connecticut and suggest the need for further violence prevention efforts.
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Affiliation(s)
- Kathleen M O'Neill
- Division of General Surgery, Trauma, and Surgical Critical Care, Department of Surgery, Yale School of Medicine, New Haven, Connecticut; Investigative Medicine Program, Yale School of Medicine, Yale Graduate School of Arts and Sciences, New Haven, Connecticut.
| | - Raymond A Jean
- Division of General Surgery, Trauma, and Surgical Critical Care, Department of Surgery, Yale School of Medicine, New Haven, Connecticut
| | - James Dodington
- Department of Pediatrics, Yale School of Medicine, New Haven, Connecticut
| | - Kimberly Davis
- Division of General Surgery, Trauma, and Surgical Critical Care, Department of Surgery, Yale School of Medicine, New Haven, Connecticut
| | - Robert D Becher
- Division of General Surgery, Trauma, and Surgical Critical Care, Department of Surgery, Yale School of Medicine, New Haven, Connecticut
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Nguyen P, Kohlbeck SA, Levas M, Hernandez-Meier J. Implementation and initial analysis of Cardiff Model data collection procedures in a level I trauma adult emergency department. BMJ Open 2022; 12:e052344. [PMID: 34992109 PMCID: PMC8739060 DOI: 10.1136/bmjopen-2021-052344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES Our understanding of community violence is limited by incomplete information, which can potentially be resolved by collecting violence-related injury information through healthcare systems in tandem with prior data streams. This study assessed the feasibility of implementing Cardiff Model data collection procedures in the emergency department (ED) setting to improve multisystem data sharing capabilities and create more representative datasets. DESIGN Information collection fields were incorporated into the ED electronic health record (EHR), which gathered additional information from patients reporting assaultive injuries. ED nurses were surveyed to evaluate implementation and feasibility of information collection. Logistic regression was performed to determine associations between missing location information and patient demographic data. SETTING 60-bed academic level I trauma adult ED in a large Midwestern city. PARTICIPANTS 2648 patients screened positive for assault injuries between 2017 and 2020. 198 patients were omitted due to age outside the range served by this ED. Unselected inclusion of 150 ED nurses was surveyed. MAIN OUTCOME MEASURES Main outcomes include nursing staff survey responses and ORs for providing complete injury information across various patient demographics. RESULTS Most ED nurses believed that information collection aligned with the hospital's mission (92%), wanted information collection to continue (88%), did not believe that information collection impacted their workflow (88%), and reported taking under 1 min to screen and document violence information (77%). 825 patients (31.2%) provided sufficient information for geospatial mapping. Likelihood of providing complete location information was significantly associated with patient gender, race, arrival means, accompaniment, trauma type and year. CONCLUSIONS It is feasible to implement information collection procedures about location-based, assault-related injuries through the EHR in the adult ED setting. Nurses reported being receptive to collecting information. Analyses suggest patient-level and time variables impact information collection completeness. The geospatial information collected can greatly improve preexisting law enforcement and emergency medical systems datasets.
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Affiliation(s)
- Peter Nguyen
- School of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Sara A Kohlbeck
- Comprehensive Injury Center, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Michael Levas
- Comprehensive Injury Center, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Jennifer Hernandez-Meier
- Comprehensive Injury Center, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
- Emergency Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
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Simske NM, Rivera T, Ren BO, Benedick A, Simpson M, Kalina M, Hendrickson SB, Vallier HA. Implementation of programming for survivors of violence-related trauma at a level 1 trauma center. Trauma Surg Acute Care Open 2021; 6:e000739. [PMID: 34693023 PMCID: PMC8499348 DOI: 10.1136/tsaco-2021-000739] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 08/29/2021] [Indexed: 11/18/2022] Open
Abstract
Background Prior investigation of violence intervention programs has been limited. This study will describe resources offered by Victims of Crime Advocacy and Recovery Program (VOCARP), their utilization, and effect on recidivism. Methods VOCARP was established in 2017 at our center, and all patients who engaged with programming (n=1019) were prospectively recorded. Patients are offered services in the emergency department, on inpatient floors and at outpatient clinic visits. Two control groups (patients sustaining violent injuries without VOCARP use (n=212) and patients with non-violent trauma (n=201)) were similarly aggregated. Results During 22 months, 96% of patients accepted education materials, 31% received financial compensation, 27% requested referrals, and 22% had crisis interventions. All other resources were used by <20% of patients. Patients who used VOCARP resources were substantially different from those who declined services; they were less often male (56% vs. 71%), more often single (79% vs. 51%), had greater unemployment (63% vs. 51%) and were less frequently shot (gunshot wound: 26% vs. 37%), all p<0.05. Overall recidivism rate was 9.4%, with no difference between groups. Use of mental health services was linked to lower recidivism rates (4.4% vs. 11.7%, p=0.016). While sexual assault survivors who used VOCARP resources had lower associated recidivism (2.4% vs. 12%, p=0.14), this was not statistically significant. Discussion This represents the largest violence intervention cohort reported to date to our knowledge. Despite substantial engagement, efficacy in terms of lower recidivism appears limited to specific subgroups or resource utilization. Level of evidence Level II. Therapeutic.
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Affiliation(s)
| | - Trenton Rivera
- Orthopedic Surgery, MetroHealth System, Cleveland, Ohio, USA
| | - Bryan O Ren
- Orthopedic Surgery, MetroHealth System, Cleveland, Ohio, USA
| | - Alex Benedick
- Orthopedic Surgery, MetroHealth System, Cleveland, Ohio, USA
| | - Megen Simpson
- Orthopedic Surgery, MetroHealth System, Cleveland, Ohio, USA
| | - Mark Kalina
- Orthopedic Surgery, MetroHealth System, Cleveland, Ohio, USA
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Strauss R, Sutradhar R, Gomez D, Luo J, Snider C, Saunders NR. Factors associated with experiencing reassault in Ontario, Canada: a population-based analysis. J Epidemiol Community Health 2021; 76:404-410. [PMID: 34620700 DOI: 10.1136/jech-2021-216964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 09/25/2021] [Indexed: 11/04/2022]
Abstract
BACKGROUND Individuals who experience a violence-related injury are at high risk for subsequent assault. The extent to which characteristics of initial assault are associated with the risk and intensity of reassaults is not well described yet essential for planning preventive interventions. We sought to describe the incidence of reassault and associated risk factors in Ontario, Canada. METHODS In this population-based retrospective cohort study using linked health and demographic administrative databases, we included all individuals discharged from an emergency department or hospitalised with a physical assault between 1 April 2005 and 30 November 2016 and followed them until 31 December 2016 for reassault. A sex-stratified Andersen-Gill recurrent events analysis modelled associations between sociodemographic and clinical risk factors and reassault. RESULTS 271 522 individuals experienced assault (mean follow-up=6.4 years), 24 568 (9.0%) of whom were reassaulted within 1 year, 45 834 (16.9%) within 5 years and 52 623 (19.4%) within 10 years. 40 322 (21%) males and 12 662 (17%) females experienced reassault over the study period. Groups with increased rates of reassault included: those aged 13-17 years versus older adults (age 65+) (males: relative rate (RR) 2.16; 95% CI 1.96 to 2.38; females: RR 2.79; 95% CI 2.39 to 3.26)), those living in rural areas versus urban (males: RR 1.22; 95% CI 1.19 to 1.24; females: RR 1.32; 95% CI 1.27 to 1.37) and individuals with a history of incarceration versus without (males: RR 2.38; 95% CI 2.33 to 2.42; females: RR 2.57; 95% CI 2.48 to 2.67). CONCLUSION One in five who are assaulted experience reassault. Those at greatest risk include youth, those living in rural areas, and those who have been incarcerated, with strongest associations among females. Timely interventions to reduce the risk of experiencing reassault must consider both sexes in these groups.
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Affiliation(s)
- Rachel Strauss
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,ICES, Toronto, Ontario, Canada
| | - Rinku Sutradhar
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,ICES, Toronto, Ontario, Canada.,Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - David Gomez
- ICES, Toronto, Ontario, Canada.,Department of Surgery, University of Toronto, Toronto, Ontario, Canada.,St Michael's Hospital, Toronto, Ontario, Canada
| | - Jin Luo
- ICES, Toronto, Ontario, Canada
| | - Carolyn Snider
- St Michael's Hospital, Toronto, Ontario, Canada.,Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Natasha Ruth Saunders
- ICES, Toronto, Ontario, Canada .,Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.,Child Health Evaluative Sciences, SickKids Research Institute, Toronto, Ontario, Canada.,Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
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27
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Nehra D, Bulger EM, Maier RV, Moloney KE, Russo J, Wang J, Anderson K, Zatzick DF. A Prospective US National Trauma Center Study of Firearm Injury Survivors Weapon Carriage and Posttraumatic Stress Disorder Symptoms. Ann Surg 2021; 274:e364-e369. [PMID: 34225296 PMCID: PMC8434993 DOI: 10.1097/sla.0000000000005043] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To describe the demographic, injury-related, and mental health characteristics of firearm injury patients and trace firearm weapon carriage and PTSD symptoms over the year after injury. SUMMARY AND BACKGROUND DATA Based on the increasing incidence of firearm injury and need for novel injury prevention strategies, hospital-based violence intervention programs are being implemented in US trauma centers. There is limited data on the long-term outcomes and risk behaviors of firearm injury survivors to guide this work. METHODS We conducted a secondary analysis of a pragmatic 25-trauma center randomized trial (N = 635). Baseline characteristics of firearm-injured patients (N = 128) were compared with other trauma patients. Mixed model regression was used to identify risk factors for postinjury firearm weapon carriage and PTSD symptoms. RESULTS Firearm injury patients were younger and more likely to be black, male and of lower socioeconomic status, and more likely to carry a firearm in the year before injury. Relative to preinjury, there was a significant drop in firearm weapon carriage at 3- and 6-months postinjury, followed by a return to preinjury levels at 12-months. Firearm injury was significantly and independently associated with an increased risk of postinjury firearm weapon carriage [relative risk = 2.08, 95% confidence interval (1.34, 3.22), P < 0.01] and higher PTSD symptom levels [Beta = 3.82, 95% confidence interval (1.29, 6.35), P < 0.01]. CONCLUSIONS Firearm injury survivors are at risk for firearm carriage and high PTSD symptom levels postinjury. The significant decrease in the high-risk behavior of firearm weapon carriage at 3-6 months postinjury suggests that there is an important postinjury "teachable moment" that should be targeted with preventive interventions. TRIAL REGISTRATION ClinicalTrials.gov NCT02655354.
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Affiliation(s)
- Deepika Nehra
- Department of Surgery, University of Washington School of Medicine, Seattle, USA
| | - Eileen M Bulger
- Department of Surgery, University of Washington School of Medicine, Seattle, USA
| | - Ronald V Maier
- Department of Surgery, University of Washington School of Medicine, Seattle, USA
| | - Kathleen E Moloney
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, USA
| | - Joan Russo
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, USA
| | - Jin Wang
- Harborview Injury Prevention and Research Center, University of Washington School of Medicine, Seattle, USA
| | - Kristina Anderson
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, USA
- The Koshka Foundation, Seattle, USA
| | - Douglas F Zatzick
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, USA
- Harborview Injury Prevention and Research Center, University of Washington School of Medicine, Seattle, USA
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Richardson JB, Wical W, Kottage N, Bullock C. Shook Ones: Understanding the Intersection of Nonfatal Violent Firearm Injury, Incarceration, and Traumatic Stress Among Young Black Men. Am J Mens Health 2021; 14:1557988320982181. [PMID: 33356779 PMCID: PMC7768853 DOI: 10.1177/1557988320982181] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Violent injury is a leading cause of death and disability among young Black men, with the highest rates occurring in low-income urban populations. Hospital-based violence intervention programs (HVIPs) offer a promising opportunity to address the biopsychosocial factors that adversely affect this population. However, there are major gaps between the needs of young Black male survivors of violent injury and the forms of care provided by HVIPs. Patient-centered outcomes research provides a useful mode of inquiry to develop strategies to decrease these differences. Care for survivors, including treatment for traumatic stress disorders, must be reconceptualized to center the lived experiences of young Black men. This paper qualitatively explores how these survivors of gun violence express symptoms of traumatic stress and the ways in which their narratives can inform the implementation of the biopsychosocial model in HVIPs. A phenomenological variant ecological systems theory framework was used to analyze participant narratives to aid in understanding their symptoms of traumatic stress and post-injury affective changes as both psychologically and socially important experiences. Such insight may inform changes to HVIP practice to address persistent health disparities related to violence.
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Affiliation(s)
- Joseph B Richardson
- Joel and Kim Feller Professor of African-American Studies and Anthropology, Department of African-American Studies and the Department of Anthropology, College of Behavioral and Social Sciences, University of Maryland College Park, College Park, MD, USA
| | - William Wical
- Department of Anthropology and the Department of African-American Studies, Transformative Research and Applied Violence Intervention Lab (TRAVAIL), College of Behavioral and Social Sciences, University of Maryland College Park, College Park, MD, USA
| | - Nipun Kottage
- Department of Anthropology and the Department of African-American Studies, Transformative Research and Applied Violence Intervention Lab (TRAVAIL), College of Behavioral and Social Sciences, University of Maryland College Park, College Park, MD, USA
| | - Che Bullock
- Department of African-American Studies, Transformative Research and Applied Violence Intervention Lab (TRAVAIL), College of Behavioral and Social Sciences, University of Maryland College Park, College Park, MD, USA
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29
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Bonne SL, Violano P, Duncan TK, Pappas PA, Baltazar GA, Dultz LA, Schroeder ME, Capella J, Hirsh M, Conrad-Schnetz K, Rattan R, Como JJ, Jewell S, Crandall ML. Prevention of Firearm Violence Through Specific Types of Community-based Programming: An Eastern Association for the Surgery of Trauma Evidence-based Review. Ann Surg 2021; 274:298-305. [PMID: 33914467 DOI: 10.1097/sla.0000000000004837] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The purpose of this review was to provide an evidence-based recommendation for community-based programs to mitigate gun violence, from the Eastern Association for the Surgery of Trauma (EAST). SUMMARY BACKGROUND DATA Firearm Injury leads to >40,000 annual deaths and >115,000 injuries annually in the United States. Communities have adopted culturally relevant strategies to mitigate gun related injury and death. Two such strategies are gun buyback programs and community-based violence prevention programs. METHODS The Injury Control and Violence Prevention Committee of EAST developed Population, Intervention, Comparator, Outcomes (PICO) questions and performed a comprehensive literature and gray web literature search. Using GRADE methodology, they reviewed and graded the literature and provided consensus recommendations informed by the literature. RESULTS A total of 19 studies were included for analysis of gun buyback programs. Twenty-six studies were reviewed for analysis for community-based violence prevention programs. Gray literature was added to the discussion of PICO questions from selected websites. A conditional recommendation is made for the implementation of community-based gun buyback programs and a conditional recommendation for community-based violence prevention programs, with special emphasis on cultural appropriateness and community input. CONCLUSIONS Gun violence may be mitigated by community-based efforts, such as gun buybacks or violence prevention programs. These programs come with caveats, notably community cultural relevance and proper support and funding from local leadership.Level of Evidence: Review, Decision, level III.
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Affiliation(s)
- Stephanie L Bonne
- Department of Surgery, Rutgers New Jersey Medical School, Newark, NJ
- The New Jersey Center for Gun Violence Research at Rutgers, Piscataway, NJ
| | - Pina Violano
- Department of Surgery, Yale New Haven Hospital, New Haven CT
| | - Thomas K Duncan
- Department of Surgery, Ventura County Medical Center, Ventura, CA
| | - Peter A Pappas
- Department of Surgery, University of Central Florida College of Medicine, Sanford, FL
| | - Gerard A Baltazar
- Department of Surgery, New York University Langone Hospital Long Island, Mineola, NY
| | - Linda A Dultz
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX
| | - Mary E Schroeder
- Department of Surgery, Medical College of Wisconsin, Milwaukee, WI
| | | | - Michael Hirsh
- Department of Surgery, University of Massachusetts Children's Medical Center, Worcester, MA
| | | | - Rishi Rattan
- Dewitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Miami, FL
| | - John J Como
- Department of Surgery, MetroHealth Medical Center, Cleveland OH
| | - Sarah Jewell
- George Smith Library, Rutgers New Jersey Medical School, Newark, NJ
| | - Marie L Crandall
- Department of Surgery, University of Florida College of Medicine, Jacksonville, FL
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30
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Lyons VH, Floyd AS, Griffin E, Wang J, Hajat A, Carone M, Benkeser D, Whiteside LK, Haggerty KP, Rivara FP, Rowhani-Rahbar A. Helping individuals with firearm injuries: A cluster randomized trial. J Trauma Acute Care Surg 2021; 90:722-730. [PMID: 33405475 PMCID: PMC7979484 DOI: 10.1097/ta.0000000000003056] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Patients with firearm injuries are at high risk of subsequent arrest and injury following hospital discharge. We sought to evaluate the effect of a 6-month joint hospital- and community-based low-intensity intervention on risk of arrest and injury among patients with firearm injuries. METHODS We conducted a cluster randomized controlled trial, enrolling patients with firearm injuries who received treatment at Harborview Medical Center, the level 1 trauma center in Seattle, Washington, were 18 years or older at the time of injury, spoke English, were able to provide consent and a method of contact, and lived in one of the five study counties. The intervention consisted of hospital-based motivational interviewing, followed by a 6-month community-based intervention, and multiagency support. The primary outcome was the risk of subsequent arrest. The main secondary outcome was the risk of death or subsequent injury requiring treatment in the emergency department or hospitalization. RESULTS Neither assignment to or engagement with the intervention, defined as having at least 1 contact point with the support specialist, was associated with risk of arrest at 2 years post-hospital discharge (relative risk for intervention assignment, 1.15; 95% confidence interval, 0.90-1.48; relative risk for intervention engagement, 1.07; 95% confidence interval, 0.74-2.19). There was similarly no association observed for subsequent injury. CONCLUSIONS This study represents one of the first randomized controlled trials of a joint hospital- and community-based intervention delivered exclusively among patients with firearm injuries. The intervention was not associated with changes in risk of arrest or injury, a finding most likely due to the low intensity of the program. LEVEL OF EVIDENCE Care management, level II.
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Affiliation(s)
- Vivian H. Lyons
- Department of Health Behavior and Health Education, University of Michigan, Ann Arbor, MI
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, WA
- Firearm Injury & Policy Research Program, Harborview Injury Prevention & Research Center, University of Washington, Seattle, WA
| | - Anthony S. Floyd
- Firearm Injury & Policy Research Program, Harborview Injury Prevention & Research Center, University of Washington, Seattle, WA
- Alcohol & Drug Abuse Institute, University of Washington, Seattle, WA
| | - Elizabeth Griffin
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, WA
| | - Jin Wang
- Firearm Injury & Policy Research Program, Harborview Injury Prevention & Research Center, University of Washington, Seattle, WA
| | - Anjum Hajat
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, WA
| | - Marco Carone
- Department of Biostatistics, University of Washington, Seattle, WA
| | - David Benkeser
- Department of Biostatistics and Bioinformatics, Emory University, Atlanta, GA
| | - Lauren K. Whiteside
- Firearm Injury & Policy Research Program, Harborview Injury Prevention & Research Center, University of Washington, Seattle, WA
- Department of Emergency Medicine, University of Washington, Seattle, WA
| | - Kevin P. Haggerty
- Firearm Injury & Policy Research Program, Harborview Injury Prevention & Research Center, University of Washington, Seattle, WA
- School of Social Work, University of Washington, Seattle, WA
- Social Development Research Group, University of Washington, Seattle, WA
| | - Frederick P. Rivara
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, WA
- Firearm Injury & Policy Research Program, Harborview Injury Prevention & Research Center, University of Washington, Seattle, WA
- Department of Pediatrics, School of Medicine, University of Washington, Seattle, WA
| | - Ali Rowhani-Rahbar
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, WA
- Firearm Injury & Policy Research Program, Harborview Injury Prevention & Research Center, University of Washington, Seattle, WA
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St Vil C, Hall EC, Sheppard M, Williams M. Testing the efficacy of a hospital-based violence intervention programme: protocol and design. Inj Prev 2020; 27:injuryprev-2020-044026. [PMID: 33328172 DOI: 10.1136/injuryprev-2020-044026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Revised: 11/22/2020] [Accepted: 11/27/2020] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Hospital-based violence intervention programmes (HBVIPs) are a promising strategy to reduce trauma recidivism and promote safety among victims of violent injury. While previous studies have demonstrated cost-effectiveness and positive impact on the lives of victims, there are a number of key limitations in the study designs of this evidence base. This study seeks to address the methodological shortcomings of previous research, determine the efficacy of HBVIPs using a randomised control study design, and provide a better understanding of successful service allocation within an HBVIP. METHODS AND ANALYSIS The current study is 1 of 12 demonstration projects being implemented around the country with the purpose of bolstering the ability to provide effective, culturally appropriate and trauma-informed services for boys and men harmed by violence. We propose a randomised control trial in which male victims of violence receive one of two interventions: treatment as usual versus enhanced services. The purpose is to determine which intervention leads to reductions in trauma recidivism over the period of 1 year from contact with the programme. Differences will also be monitored on measures of mental health, quality of life and attitudes towards violence. Analyses employed will include Kaplan-Meier analysis and Cox proportional hazards regression with death and recidivism being the outcomes of interest. ETHICS AND DISSEMINATION Study procedures have been approved by the Institutional Review Boards of the University at Buffalo and four hospitals. Results will be submitted for publication in peer-reviewed journals.
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Affiliation(s)
- Christopher St Vil
- School of Social Work, University at Buffalo - The State University of New York, Buffalo, New York, USA
- Harborview Injury Prevention & Research Center, Seattle, Washington, USA
| | - Erin C Hall
- Department of Surgery, Georgetown University Medical Center, Washington, District of Columbia, USA
| | - Mildred Sheppard
- Community Violence Intervention Program, MedStar Washington Hospital Center, Washington, District of Columbia, USA
| | - Mallory Williams
- Department of Surgery, Howard University College of Medicine, Washington, District of Columbia, USA
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Walker GN, Dekker AM, Hampton DA, Akhetuamhen A, Moore PQ. A Case for Risk Stratification in Survivors of Firearm and Interpersonal Violence in the Urban Environment. West J Emerg Med 2020; 21:132-140. [PMID: 33207158 PMCID: PMC7673864 DOI: 10.5811/westjem.2020.8.45041] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2019] [Accepted: 08/06/2020] [Indexed: 11/11/2022] Open
Abstract
The emergency department (ED) serves as the main source of care for patients who are victims of interpersonal violence. As a result, emergency physicians across the nation are at the forefront of delivering care and determining dispositions for many at-risk patients in a dynamic healthcare environment. In the majority of cases, survivors of interpersonal violence are treated and discharged based on the physical implications of the injury without consideration for risk of reinjury and the structural drivers that may be at play. Some exceptions may exist at institutions with hospital-based violence intervention programs (HVIPs). At these institutions, disposition decisions often include consideration of a patient’s risk for repeat exposure to violence. Ideally, HVIP services would be available to all survivors of interpersonal violence, but a variety of current constraints limit availability. Here we offer a scoping review of HVIPs and our perspective on how risk-stratification could help emergency physicians determine which patients will benefit most from HVIP services and potentially reduce re-injury secondary to interpersonal violence.
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Affiliation(s)
- Garth N Walker
- Northwestern Buehler Center Health Economics and Policy and Northwestern Department of Emergency Medicine, Chicago, Illinois
| | - Annette M Dekker
- University of California, Los Angeles, Department of Emergency Medicine, Los Angeles, California
| | - David A Hampton
- University of Chicago, Department of Surgery, Section of Trauma and Acute Care Surgery, Chicago, Illinois
| | - Adesuwa Akhetuamhen
- Northwestern Buehler Center Health Economics and Policy and Northwestern Department of Emergency Medicine, Chicago, Illinois
| | - P Quincy Moore
- University of Chicago, Department of Medicine, Section of Emergency Medicine, Chicago, Illinois
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Beam DR, Szabo A, Olson J, Hoffman L, Beyer KMM. Vacant lot to community garden conversion and crime in Milwaukee: a difference-in-differences analysis. Inj Prev 2020; 27:403-408. [PMID: 32912967 DOI: 10.1136/injuryprev-2020-043767] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 08/11/2020] [Accepted: 08/14/2020] [Indexed: 11/03/2022]
Abstract
BACKGROUND Vacant lots generate the perception of neglect and are often opportunistic locations for crime. Evidence is building to suggest that greening vacant lots, especially through community engaged approaches, is associated with reductions in some types of crime. METHODS Using a retrospective quasi-experimental approach, we compared the conversion of vacant lots into community gardens (n=53) with a group of matched control lots (n=159) to examine the effect of this intervention on police reported theft, violent and nuisance crime in Milwaukee, Wisconsin. Conversions often involved the addition of planter boxes to create a garden, and sometimes included benches, paths, works of art or other landscaping features. Public crime data were used to generate crime rates within 100 m and 250 m around each lot. RESULTS Violent and nuisance crime rates are lower near treatment lots based on an unadjusted difference-in-differences analysis of means and two Poisson regression models. While no substantial effects were observed among theft crimes, the most consistent crime rate reductions were found among violent crime within 250 m, ranging between 3.7% and 6.4% across analyses. CONCLUSIONS Despite the small number of interventions, community-driven vacant lot to garden conversions were associated with slight reductions in crime. Urban greening initiatives may be a promising strategy to reduce urban crime and warrant further study.
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Affiliation(s)
- David R Beam
- Division of Epidemiology, Institute for Health and Equity, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Aniko Szabo
- Division of Biostatistics, Institute for Health and Equity, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Jared Olson
- Division of Epidemiology, Institute for Health and Equity, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | | | - Kirsten M M Beyer
- Division of Epidemiology, Institute for Health and Equity, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
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Abstract
BACKGROUND Survivors of gun violence may develop significant mental health sequelae and are at higher risk for reinjury through repeat violence. Despite this, survivors of gun violence often return to the community where they were injured with suboptimal support for their mental health, emotional recovery, and well-being. The goal of this study was to characterize the posthospitalization recovery experience of survivors of gun violence. METHODS We conducted a qualitative research study with a community-based participatory research approach. In partnership with a community-based organization, we conducted in-depth one-on-one interviews and used snowball sampling to recruit survivors of gun violence. We applied the constant comparison method of qualitative analysis to catalogue interview transcript data by assigning conceptual codes and organizing them into a consensus list of themes. We presented the themes back to the participants and community members for confirmation. RESULTS We conducted 20 interviews with survivors of gun violence; all were black men, aged 20 years to 51 years. Five recurring themes emerged: (1) Isolation, physical and social restriction due to fear of surroundings; (2) Protection, feeling unsafe leading to the desire to carry a gun; (3) Aggression, willingness to use a firearm in an altercation; (4) Normalization, lack of reaction driven by the ubiquity of gun violence in the community; and (5) Distrust of health care providers, a barrier to mental health treatment. CONCLUSION Survivors of gun violence describe a disrupted sense of safety following their injury. As a result, they experience isolation, an increased need to carry a firearm, a normalization of gun violence, and barriers to mental health treatment. These maladaptive reactions suggest a mechanism for the violent recidivism seen among survivors of gun violence and offer potential targets to help this undertreated, high-risk population. LEVEL OF EVIDENCE Care management/Therapeutic V.
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35
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Eastern Association for the Surgery of Trauma (EAST) practice management guidelines and the perpetual quest for excellence. J Trauma Acute Care Surg 2020; 89:1-10. [PMID: 32251261 DOI: 10.1097/ta.0000000000002709] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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36
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Lyons VH, Benson LR, Griffin E, Floyd AS, Kiche SW, Haggerty KP, Whiteside L, Conover S, Herman DB, Rivara FP, Rowhani-Rahbar A. Fidelity Assessment of a Social Work-Led Intervention Among Patients with Firearm Injuries. RESEARCH ON SOCIAL WORK PRACTICE 2020; 30:678-687. [PMID: 32973371 PMCID: PMC7508463 DOI: 10.1177/1049731520912002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
PURPOSE To support future development and refinement of social work-led intervention programs among patients with firearm injuries and to demonstrate how a fidelity assessment can be used to adjust and refine intervention delivery in an ongoing trial. METHODS We conducted a fidelity assessment of a randomized controlled trial of a social work-led intervention among patients with a firearm injury. RESULTS We found that our study intervention was well implemented, meeting 70% of the fidelity assessment score items, however noted lower fidelity with client-based items. DISCUSSION As a result of fidelity assessment findings, we refined intervention delivery to improve implementation fidelity including beginning to review cases of all patients each month, rather than focusing on patients in crisis. Our fidelity assessment process and findings offer insight into the challenges of implementing an intervention among patients with firearm injuries and highlights the value of monitoring intervention fidelity during an ongoing trial.
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Affiliation(s)
- Vivian H. Lyons
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, WA
- Firearm Injury & Policy Research Program, Harborview Injury Prevention & Research Center, University of Washington, Seattle, WA
| | - Lina R. Benson
- The Alcohol & Drug Abuse Institute, University of Washington, Seattle, WA
| | - Elizabeth Griffin
- Firearm Injury & Policy Research Program, Harborview Injury Prevention & Research Center, University of Washington, Seattle, WA
| | - Anthony S. Floyd
- Firearm Injury & Policy Research Program, Harborview Injury Prevention & Research Center, University of Washington, Seattle, WA
- The Alcohol & Drug Abuse Institute, University of Washington, Seattle, WA
| | - Sharon W. Kiche
- Firearm Injury & Policy Research Program, Harborview Injury Prevention & Research Center, University of Washington, Seattle, WA
| | - Kevin P. Haggerty
- Firearm Injury & Policy Research Program, Harborview Injury Prevention & Research Center, University of Washington, Seattle, WA
- School of Social Work, University of Washington, Seattle, WA
- Social Development Research Group, University of Washington, Seattle, WA
| | - Lauren Whiteside
- Firearm Injury & Policy Research Program, Harborview Injury Prevention & Research Center, University of Washington, Seattle, WA
- Department of Emergency Medicine, University of Washington, Seattle, WA
| | - Sarah Conover
- Center for the Advancement of Critical Time Intervention, Hunter College, NY
- Silberman School of Social Work, Hunter College, NY
| | - Daniel B. Herman
- Center for the Advancement of Critical Time Intervention, Hunter College, NY
- Silberman School of Social Work, Hunter College, NY
| | - Frederick P. Rivara
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, WA
- Firearm Injury & Policy Research Program, Harborview Injury Prevention & Research Center, University of Washington, Seattle, WA
- Department of Pediatrics, School of Medicine, University of Washington, Seattle, WA
| | - Ali Rowhani-Rahbar
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, WA
- Firearm Injury & Policy Research Program, Harborview Injury Prevention & Research Center, University of Washington, Seattle, WA
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Abstract
Hoping to reduce the number of repeat visitors, one Washington, D.C., hospital is providing short- and long-term support to victims of violence.
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Affiliation(s)
- T R Goldman
- This article is part of a series on transforming health systems published with support from The Robert Wood Johnson Foundation. This is an open access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, which permits others to distribute, remix, adapt, and build upon this work, for commercial use, provided the original work is properly cited. See https://creativecommons.org/licenses/by/4.0/ . T. R. Goldman ( trgoldman1@gmail. com ) is a Washington, D.C.-based freelance journalist
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The scales of recovery: Balancing posttraumatic stress with resilience in the violently injured. J Trauma Acute Care Surg 2020; 89:208-214. [DOI: 10.1097/ta.0000000000002622] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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American Association for the Surgery of Trauma Prevention Committee topical update: Impact of community violence exposure, intimate partner violence, hospital-based violence intervention, building community coalitions and injury prevention program evaluation. J Trauma Acute Care Surg 2020; 87:456-462. [PMID: 31349352 DOI: 10.1097/ta.0000000000002313] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
An effective injury prevention program is an important component of a successful trauma system. Maintaining support for a hospital-based injury prevention program is challenging, given competing institutional and trauma program priorities and limited resources. In light of those pressures, the American College of Surgeons Committee on Trauma mandates that trauma centers demonstrate financial support for an injury prevention program as part of the verification process, recognizing that hospital administrators might see such support as discretionary and ripe as a target for expense reduction efforts. This Topical Update from the American Association for the Surgery of Trauma Injury Prevention Committee focuses on strategies to be more effective with the limited resources that are allocated to hospital-based injury prevention programs. First, this review tackles two of the many social determinates of violence, including activities aimed at mitigating the impact of both community violence exposure and intimate partner/domestic violence. Developing or participating in coalitions for injury prevention, both in general with any injury prevention initiative, and specifically while developing a hospital-based violence intervention program, efficiently extends the hospital's efforts by gaining access to expertise, resources, and influence over the target population that the hospital might otherwise have difficulty impacting. Finally, the importance of systematic program evaluation is explored. In an era of dwindling resources for injury prevention, both at the national level and the institutional level, it is important to measure the effectiveness of injury prevention efforts on the target population, and when necessary, make changes to programs to both improve their effectiveness and to assist organizations in making wise choices in the use of their limited resources.
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Grossman DC, Choucair B. Violence And The US Health Care Sector: Burden And Response. Health Aff (Millwood) 2019; 38:1638-1645. [DOI: 10.1377/hlthaff.2019.00642] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Affiliation(s)
- David C. Grossman
- David C. Grossman is senior investigator at the Kaiser Permanente Washington Health Research Institute, in Seattle
| | - Bechara Choucair
- Bechara Choucair is senior vice president and chief community health officer at Kaiser Permanente in Oakland, California
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Ranney M, Karb R, Ehrlich P, Bromwich K, Cunningham R, Beidas RS. What are the long-term consequences of youth exposure to firearm injury, and how do we prevent them? A scoping review. J Behav Med 2019; 42:724-740. [PMID: 31367937 PMCID: PMC8321509 DOI: 10.1007/s10865-019-00035-2] [Citation(s) in RCA: 61] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Accepted: 03/23/2019] [Indexed: 12/14/2022]
Abstract
The long-term consequences of exposure to firearm injury-including suicide, assault, and mass shootings-on children's mental and physical health is unknown. Using PRISMA-ScR guidelines, we conducted a scoping review of four databases (PubMed, Scopus, PsychINFO, and CJ abstract) between January 1, 1985 and April 2, 2018 for articles describing long-term outcomes of child or adolescent firearm injury exposure (n = 3582). Among included studies (n = 31), most used retrospective cohorts or cross-sectional studies to describe the correlation between firearm injury and post-traumatic stress. A disproportionate number of studies examined the effect of mass shootings, although few of these studies were conducted in the United States and none described the impact of social media. Despite methodologic limitations, youth firearm injury exposure is clearly linked to high rates of post-traumatic stress symptoms and high rates of future injury. Evidence is lacking on best practices for prevention of mental health and behavioral sequelae among youth exposed to firearm injury. Future research should use rigorous methods to identify prevalence, correlates, and intervention strategies for these at-risk youth.
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Affiliation(s)
- Megan Ranney
- Department of Emergency Medicine, Alpert Medical School, Brown University, 593 Eddy Street, Claverick 2, Providence, RI, 02903, USA.
- Department of Health Services, Policy, and Practice, School of Public Health, Brown University, 121 South Main Street, Providence, RI, 02903, USA.
- American Foundation for Firearm Injury Reduction in Medicine, PO Box 503, Williamstown, MA, 01267, USA.
| | - Rebecca Karb
- Department of Emergency Medicine, Alpert Medical School, Brown University, 593 Eddy Street, Claverick 2, Providence, RI, 02903, USA
| | - Peter Ehrlich
- Department of Surgery, Section of Pediatric Surgery, University of Michigan School of Medicine, 1500 East Medical Center Drive, Ann Arbor, MI, 48109, USA
| | - Kira Bromwich
- Department of Emergency Medicine, Alpert Medical School, Brown University, 593 Eddy Street, Claverick 2, Providence, RI, 02903, USA
| | - Rebecca Cunningham
- Department of Emergency Medicine, University of Michigan School of Medicine, 1500 East Medical Center Drive, Ann Arbor, MI, 48109, USA
- School of Public Health, University of Michigan, 1415 Washington Heights, Ann Arbor, MI, 48109, USA
| | - Rinad S Beidas
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, 3535 Market Street, 3015, Philadelphia, PA, 19104, USA
- Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, 3400 Civic Center Boulevard, Philadelphia, PA, 19104, USA
- Leonard Davis Institute of Health Economics, University of Pennsylvania, 3641 Locust Walk #210, Philadelphia, PA, 19104, USA
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Leeds IL, Meyers PM, Enumah ZO, He J, Burkhart RA, Haut ER, Efron JE, Johnston FM. Psychosocial Risks are Independently Associated with Cancer Surgery Outcomes in Medically Comorbid Patients. Ann Surg Oncol 2019; 26:936-944. [DOI: 10.1245/s10434-018-07136-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Indexed: 11/18/2022]
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Fischer KR, Bakes KM, Corbin TJ, Fein JA, Harris EJ, James TL, Melzer-Lange MD. Trauma-Informed Care for Violently Injured Patients in the Emergency Department. Ann Emerg Med 2018; 73:193-202. [PMID: 30503381 DOI: 10.1016/j.annemergmed.2018.10.018] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Revised: 10/08/2018] [Accepted: 10/11/2018] [Indexed: 10/27/2022]
Abstract
Violent traumatic injury remains a common condition treated by emergency physicians. The medical management of these patients is well described and remains an area of focus for providers. However, violently injured patients disproportionately carry a history of physical and psychological trauma that frequently affects clinical care in the emergency department. The alteration of our clinical approach, taking into consideration how a patient's previous experiences influence how he or she may perceive and react to medical care, is a concept referred to as trauma-informed care. This approach is based on 4 pillars: knowledge of the effect of trauma, recognition of the signs and symptoms of trauma, avoidance of retraumatization, and the development of appropriate policies and procedures. Using this framework, we provide practical considerations for emergency physicians in the delivery of trauma-informed care for violently injured patients.
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Affiliation(s)
- Kyle R Fischer
- Department of Emergency Medicine, and University of Maryland School of Medicine, Baltimore, MD.
| | - Katherine M Bakes
- Department of Emergency Medicine, University of Colorado School of Medicine, Denver, CO
| | - Theodore J Corbin
- Department of Emergency Medicine, Drexel University College of Medicine, Philadelphia, PA
| | - Joel A Fein
- Departments of Pediatrics and Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Erica J Harris
- Department of Emergency Medicine, Einstein Medical Center Philadelphia, Philadelphia, PA
| | - Thea L James
- Department of Emergency Medicine, Boston Medical Center/Boston University School of Medicine, Boston, MA
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Coupet E, Karp D, Wiebe DJ, Kit Delgado M. Shift in U.S. payer responsibility for the acute care of violent injuries after the Affordable Care Act: Implications for prevention. Am J Emerg Med 2018; 36:2192-2196. [PMID: 29653788 DOI: 10.1016/j.ajem.2018.03.070] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Revised: 03/27/2018] [Accepted: 03/27/2018] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Investment in violence prevention programs is hampered by lack of clearly identifiable stakeholders with a financial stake in prevention. We determined the total annual charges for the acute care of injuries from interpersonal violence and the shift in financial responsibility for these charges after the Medicaid expansion from the Affordable Care Act in 2014. METHODS We analyzed all emergency department (ED) visits from 2009 to 2014 with diagnosis codes for violent injury in the Nationwide Emergency Department Sample (NEDS). We used sample weights to estimate total charges with adjusted generalized linear models to estimate charges for the 15% of ED visits with missing charge data. We then calculated the share attributable by payer and determined the difference in proportion by payer from 2013 to 2014. RESULTS Between 2009 and 2013, the uninsured accounted for 28.2-31.3% of annual charges for the acute care of violent injury, while Medicaid was responsible for a similar amount (29.0-31.0%). In 2014, there were $10.7 billion in total charges for violent injury. Medicaid assumed the greatest share, 39.8% (95% CI: 38.0-41.5%, $3.5-5.1 billion), while the uninsured accounted for 23.6% (95% CI: 22.2-24.9%, $2.0-3.0 billion), and Medicare accounted for 7.8% (95% CI: 7.7-8.0%, $0.7-1.0 billion). CONCLUSION After Medicaid expansion, taxpayers are now accountable for nearly half of the $10.7 billion in annual charges for the acute care of violent injury in the U.S. These findings highlight the benefit to state Medicaid programs of preventing interpersonal violence.
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Affiliation(s)
- Edouard Coupet
- Master's in Health Policy Research Program, University of Pennsylvania, United States; Center for Emergency Care Policy and Research, Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, United States; Leonard Davis Institute of Health Economics, University of Pennsylvania, United States.
| | - David Karp
- Center for Emergency Care Policy and Research, Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, United States
| | - Douglas J Wiebe
- Center for Emergency Care Policy and Research, Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, United States; Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, United States; Penn Injury Science Center, University of Pennsylvania, United States; Leonard Davis Institute of Health Economics, University of Pennsylvania, United States
| | - M Kit Delgado
- Center for Emergency Care Policy and Research, Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, United States; Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, United States; Penn Injury Science Center, University of Pennsylvania, United States; Leonard Davis Institute of Health Economics, University of Pennsylvania, United States
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