使用区域健康信息交换对基于医院的暴力干预项目进行长期评估。
Long-term evaluation of a hospital-based violence intervention program using a regional health information exchange.
作者信息
Bell Teresa M, Gilyan Dannielle, Moore Brian A, Martin Joel, Ogbemudia Blessing, McLaughlin Briana E, Moore Reilin, Simons Clark J, Zarzaur Ben L
机构信息
From the Department of Surgery (T.M.B., B.O., B.E.M., R.M., C.J.S., B.L.Z.), Indiana University School of Medicine, Indianapolis, Indiana; Smith Level I Shock Trauma Center (D.G., B.A.M., C.J.S., B.L.Z.), Eskenazi Hospital, Indianapolis, Indiana; and Regenstrief Institute (J.M.), Indianapolis, Indiana.
出版信息
J Trauma Acute Care Surg. 2018 Jan;84(1):175-182. doi: 10.1097/TA.0000000000001671.
BACKGROUND
Hospital-based violence intervention programs (HVIP) aim to reduce violent-injury recidivism by providing intensive case management services to high-risk patients who were violently injured. Although HVIP have been found effective at reducing recidivism, few studies have sought to identity how long their effects last. Additionally, prior studies have been limited by the fact that HVIP typically rely on self-report or data within their own healthcare system to identify new injuries. Our aim was to quantify the long-term recidivism rate of participants in an HVIP program using more objective and comprehensive data from a regional health information exchange.
METHODS
The study included 328 patients enrolled in Prescription for Hope (RxH), an HVIP, between January 2009 and August 2016. We obtained RxH participants' emergency department (ED) encounter data from a regional health information exchange database from the date of hospital discharge to February 2017. Our primary outcome was violent-injury recidivism rate of the RxH program. We also examined reasons for ED visits that were unrelated to violent injury.
RESULTS
We calculated a 4.4% recidivism rate based on 8 years of statewide data, containing 1,575 unique encounters. More than 96% of participants were matched in the state database. Of the 15 patients who recidivated, only five were admitted for their injury. More than half of new violence-related injuries were treated outside of the HVIP-affiliated trauma center. The most common reasons for ED visits were pain (718 encounters), followed by suspected complications or needing additional postoperative care (181 encounters). Substance abuse, unintentional injuries, and suicidal ideation were also frequent reasons for ED visits.
CONCLUSION
The low, long-term recidivism rate for RxH indicates that HVIPs have enduring positive effects on the majority of participants. Our results suggest that HVIP may further benefit patients by partnering with organizations that work to prevent suicide, substance use disorders, and other unintentional injuries.
LEVEL OF EVIDENCE
Therapeutic study, level III.
背景
基于医院的暴力干预项目（HVIP）旨在通过为遭受暴力伤害的高危患者提供强化病例管理服务，降低暴力伤害再发率。尽管已发现HVIP在降低再发率方面有效，但很少有研究试图确定其效果能持续多久。此外，既往研究因HVIP通常依赖自我报告或自身医疗系统内的数据来识别新伤而受到限制。我们的目的是使用来自区域健康信息交换的更客观和全面的数据，量化HVIP项目参与者的长期再发率。
方法
该研究纳入了2009年1月至2016年8月期间参加HVIP“希望处方”（RxH）的328名患者。我们从区域健康信息交换数据库中获取了RxH参与者从出院日期至2017年2月的急诊科就诊数据。我们的主要结局是RxH项目的暴力伤害再发率。我们还检查了与暴力伤害无关的急诊科就诊原因。
结果
基于8年的全州数据，我们计算出再发率为4.4%，包含1575次独立就诊。超过96%的参与者在州数据库中匹配成功。在15名再发的患者中，只有5名因伤入院。超过一半的新的暴力相关伤害是在与HVIP相关的创伤中心之外接受治疗的。急诊科就诊的最常见原因是疼痛（718次就诊），其次是疑似并发症或需要额外的术后护理（181次就诊）。药物滥用、意外伤害和自杀意念也是急诊科就诊的常见原因。
结论
RxH的低长期再发率表明HVIP对大多数参与者有持久的积极影响。我们的结果表明，HVIP通过与致力于预防自杀、物质使用障碍和其他意外伤害的组织合作，可能会进一步使患者受益。
证据水平
治疗性研究，III级。
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