What's the burden of violence on health systems? Kaiser Permanente set out to quantify it

The most current data suggest violence has a substantial impact on health systems, but research gaps persist, hampering progress toward solutions. (Getty/Shidlovski)

What's the cost of violence on health systems?

In 2017 alone, 2.3 million emergency department visits and the 376,500 hospitalizations they spawned contributed to an estimated $8.7 billion in medical costs. Tack onto that the estimated $429 million cost from violence against healthcare workers—who experience the highest rates of violent workplace injuries—and you've got a costly problem. 

That's according to a new report from Kaiser Permanente on the burden of violence on health systems, which offers a glimpse of the problem’s massive scope. The study, published in the October issue of Health Affairs, provides the latest available data on the various impacts violence has on health systems and offers guidance for health systems as they begin to address the issue.

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“The data cited in this article are the very most recent data we can find anywhere. The absence of high-quality surveillance data is a definite problem in this area—and I think it is consistent with another larger problem with the lack of resources that are allocated to doing any kind of research and surveillance,” said study author David Grossman, M.D., a senior investigator and pediatrician at Kaiser Permanente Washington as well as senior medical director for the Washington Permanente Medical Group.

For example, Grossman points out that the Centers for Disease Control and Prevention’s National Violent Death Reporting System has not attracted enough funding to enable all 50 states to use it. “We don’t even have a complete picture on violent victimization and, for that matter, the use of firearms in those violent injuries across all 50 states,” he said. By contrast, Grossman points out that the national surveillance system for motor vehicles has produced robust data, leading to successful interventions in areas like highway safety and efforts to reduce drunk driving.

Health systems also feel the effects of indirect costs related to violence. Healthcare workers experience the highest rate of workplace violence among all workplace types surveyed by the Occupational Safety and Health Administration. In 2016, hospitals spent $428.5 million dealing with the consequences of violence in their facilities, including the cost of medical and disability care as well as productivity losses.

It’s not even clear that the money health systems spend to keep their workers safe gets spent effectively, because it simply hasn’t been studied. “This is another area where, frankly, there’s been a complete gap in terms of funding for research,” Grossman said. 

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Even with these gaps in the current data, violence clearly takes a significant enough collective toll on health systems and staff to merit targeted interventions. Grossman’s research suggests there’s strong evidence that improving clinicians’ ability to detect and treat depression and remove firearms from people at high risk of suicide would provide a solid start.

“There are some gaps that we still need to fill in with regard to how to interview with regard specifically to a gun or firearm, but we know enough to know that there’s a lot of room for improvement in the United States in the realm of screening and treatment of depression,” he said.

Programs targeting the causes of violence by intervening in communities where it takes place have shown some initial promise as well, but their use has not been widespread enough to provide an evidence base for rolling them out more broadly. In the absence of sufficient funding and with the political sensitivity around research into gun violence, Grossman said organizations such as Kaiser Permanente have had to take it on themselves to support research in this area.

“If you look at every other kind of injury control research, whether it be motor vehicles or fires or child passenger safety, there have been huge gains in the field of injury prevention because of investments in research. So I think that the hesitancy to invest limits our ability to understand both what’s going on exactly, and also what works,” Grossman said.

“This article is a good opportunity for us to understand and look for where we can make additional investments not just in research, but also in terms of quality improvement in our own healthcare system,” he said.