一项基于医院的区域暴力干预项目评估：一项试点队列研究。
Evaluation of a Region-Wide Hospital-Based Violence Intervention Program : A Pilot Cohort Study.
作者信息
Mueller Kristen L, Kaser Taylor M, Cooper Benjamin P, Lew Daphne, Moran Vicki, Ancona Rachel M, Chapman-Kramer Kateri, Coffey Melik, Page Keyria, Batha Abigail, Harris Stephanie, Rice-Barnes Larita, Williams Marsha, Kranker Lindsay M, Spruce Marguerite W, Behr Christopher, Mancini Michael A, Schuerer Douglas J E, Clukies Lindsay D, Santucci Nicole, Trolard Anne, Anwuri Victoria, Ranney Megan L, Foraker Randi E, Vogel Matt
机构信息
Department of Emergency Medicine, Washington University in St. Louis School of Medicine, St. Louis, Missouri (K.L.M., T.M.K., R.M.A.).
Institute for Public Health, Washington University in St. Louis School of Medicine, St. Louis, Missouri (B.P.C., K.C.-K., A.T.).
出版信息
Ann Intern Med. 2025 Aug;178(8):1116-1126. doi: 10.7326/ANNALS-24-01576. Epub 2025 Jul 15.
BACKGROUND
Violent injury survivors are at risk for revictimization. The St. Louis area hospital-based violence intervention program (HVIP), Life Outside of Violence (LOV), is the first multisystem, region-wide HVIP in the United States.
OBJECTIVE
To describe the LOV program during its pilot phase and evaluate violent reinjury 1 year after index injury among LOV participants.
DESIGN
Pilot observational cohort study of violently injured patients.
SETTING
Data were queried from the program's multisystem data repository, which contains individual encounter-level data for all violent injury visits from the 2 adult and 2 pediatric LOV-partner level 1 trauma hospitals.
PARTICIPANTS
Patients eligible for LOV who were violently injured between 15 August 2018 and 31 December 2022 and enrolled in LOV, matched to control participants of nonenrolled LOV-eligible patients selected from the data repository using propensity score matching.
INTERVENTION
Participation in the LOV program.
MEASUREMENTS
Sociodemographic characteristics, predictors of LOV enrollment, and returning to a LOV partner hospital with a violent reinjury within 1 year of index injury. The probability of violent reinjury and 95% CIs were compared between LOV participants and control participants using Kaplan-Meier estimates.
RESULTS
233 of 3744 eligible patients enrolled in LOV. Of 198 LOV-enrolled participants matched to 388 nonenrolled control participants, Kaplan-Meier estimates for 1-year probability of reinjury were 7.6% (95% CI, 3.8% to 11.2%) among LOV participants and 7.4% (CI, 4.8% to 10.0%) in control participants.
LIMITATION
This pilot study cannot provide precise estimates of LOV intervention efficacy.
CONCLUSION
Although no informative evidence of differences in reinjury probability for LOV participants was seen, findings suggest that the overwhelming risk in which our patients are immersed cannot be overcome by an approach scaled for individual-level impact.
PRIMARY FUNDING SOURCE
Missouri Foundation for Health.
背景
暴力伤害幸存者有再次受害的风险。圣路易斯地区基于医院的暴力干预项目（HVIP），即“暴力之外的生活”（LOV），是美国首个多系统、覆盖全地区的HVIP。
目的
描述LOV项目试点阶段的情况，并评估LOV参与者在首次受伤后1年的暴力再受伤情况。
设计
对暴力受伤患者的试点观察性队列研究。
设置
从该项目的多系统数据存储库中查询数据，该存储库包含来自2家成人和2家儿科LOV合作的一级创伤医院的所有暴力伤害就诊的个体诊疗数据。
参与者
2018年8月15日至2022年12月31日期间因暴力受伤且符合LOV条件并登记参加该项目的患者，与使用倾向得分匹配从数据存储库中选取的未登记的符合LOV条件的对照参与者进行匹配。
干预措施
参与LOV项目。
测量指标
社会人口学特征、LOV登记的预测因素，以及在首次受伤后1年内因暴力再受伤返回LOV合作医院的情况。使用Kaplan-Meier估计值比较LOV参与者和对照参与者之间暴力再受伤的概率及95%置信区间。
结果
3744名符合条件的患者中有233名登记参加了LOV。在198名登记参加LOV的参与者与388名未登记的对照参与者中，Kaplan-Meier估计的LOV参与者1年再受伤概率为7.6%（95%CI，3.8%至11.2%），对照参与者为7.4%（CI，4.8%至10.0%）。
局限性
这项试点研究无法提供LOV干预效果的精确估计。
结论
虽然未发现LOV参与者在再受伤概率方面存在差异的有效证据，但研究结果表明，我们的患者所面临的巨大风险无法通过针对个体层面影响的方法来克服。
主要资金来源
密苏里健康基金会。
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