David C. Grossman ( David. C. Grossman@kp. org ) is senior investigator at the Kaiser Permanente Washington Health Research Institute, in Seattle.
Bechara Choucair is senior vice president and chief community health officer at Kaiser Permanente in Oakland, California.
Health Aff (Millwood). 2019 Oct;38(10):1638-1645. doi: 10.1377/hlthaff.2019.00642.
Violence has significant impacts on the US health care sector, which include the need to care for injured victims and prevent violence to its physicians and employees, as well as the surrounding community. In 2017 violence resulted in about 2.3 million emergency department visits and 376,500 hospitalizations, with an estimated total medical cost of about $8.7 billion. Victims also often need short- and long-term physical and psychological rehabilitation. Health care workers experience the highest rates of violent injuries in the workplace in the US: 7.8 per 1,000 workers per year, compared to rates under 2.0 per 1,000 for other private industry. Treating and preventing injuries to workers in 2016 added an estimated $429 million in direct and indirect costs to US health systems. Health systems and clinicians have embraced screening and interventions in primary care, mental health care, emergency departments, and other clinical settings to prevent violence among high-risk patients, including potential victims of intimate partner violence, victims of youth violence, and suicidal patients. Some interventions include addressing patients' access to firearms, the most lethal method for assaults and suicides. Community health needs assessments help health systems identify violence as a key community health priority and lead to improvements in the delivery of violence prevention programs.
暴力行为对美国医疗保健部门造成了重大影响，包括需要照顾受伤的受害者，防止对其医生和员工以及周边社区的暴力行为。2017 年，暴力行为导致约 230 万例急诊就诊和 37.65 万例住院治疗，估计医疗费用总计约 87 亿美元。受害者还经常需要短期和长期的身体和心理康复。在美国，医疗保健工作者在工作场所遭受暴力伤害的比率最高：每 1000 名工人中有 7.8 人，而其他私营行业每 1000 人中有不到 2.0 人。2016 年，治疗和预防工人受伤给美国卫生系统增加了约 4.29 亿美元的直接和间接成本。卫生系统和临床医生已经在初级保健、心理健康保健、急诊室和其他临床环境中采用了筛查和干预措施，以预防高危患者中的暴力行为，包括亲密伴侣暴力的潜在受害者、青少年暴力的受害者和自杀患者。一些干预措施包括解决患者获得枪支的问题，枪支是攻击和自杀最致命的手段。社区卫生需求评估有助于卫生系统将暴力行为确定为一个关键的社区卫生重点，并改善预防暴力方案的实施。
