Using Hospital Discharge Data to Measure the Scope of

Using Hospital Discharge Data to Measure the Scope of Intimate Partner Violence Injuries in California Laura E. Lund, M.A. Roger Trent, Ph.D. California Department of Health Services February and March 2003 Statewide Data Sources for Measuring Intimate Partner Violence • Nonfatal – Patient Discharge Data – California Women’s Health Survey – Future ED reporting • Fatal – Vital Statistics Death Records – Supplementary Homicide Reports – EPIC’s Linked Homicide File • Other – DOJ arrest data Patient Discharge Data • Available information includes – Diagnosis and injury codes – Demographics of victim – Information about the hospital stay, payer, etc. • • • • In California, reporting of E-codes is mandatory Reporting is close to 100 percent statewide Limited to hospital admissions Only one code identifies IPV victims (E967.3) How Can Patient Discharge Data Be Used to Provide Information on Intimate Partner Violence? • Assess the magnitude of the injury problem in the state and at the local level • Monitor trends in number of persons affected and types of injuries • Provide information on groups at high risk for this type of injury (e.g., young women, poor women) Violent Injury Hospitalization Rates per 100,000 Females, by Age, California, 1992-1999 35 30 Rate per 100,000 25 20 15 10 5 0 Prepared by California Department of Health Services, EPIC Branch Source: California Office of Statewide Health Planning and Development, Patient Discharge Data; California Department of Finance, Race/Ethnic Population with Age and Sex Detail <13 13-19 20-29 30-39 40-49 50-64 65+ Hospitalizations for IPV Injuries, Females, by Age, California, 1996-1999 180 Number of hospitalizations 160 140 120 100 80 60 40 20 0 Prepared by California Department of Health Services, EPIC Branch Source: California Office of Statewide Health Planning and Development, Patient Discharge Data <13 13-19 20-29 30-39 40-49 50-64 65+ Hospitalized Violent Injuries in California, by Type of Weapon and Average Charges Billed per Hospitalization, All Ages, 1992-1999 Thousands of dollars 30 25 20 15 10 5 0 Firearms Knives Beating Abuse and Neglect Struck by Object Intimate Partner Abuse Prepared by California Department of Health Services, EPIC Branch Source: California Office of Statewide Health Planning and Development, Patient Discharge Data Hospitalized Violent Injuries in California, by Type of Weapon and Average Length of Stay, All Ages, 1992-1999 10 Number of days 8 6 4 2 0 Firearms Knives Beating Abuse and Neglect Struck by Object Intimate Partner Abuse Prepared by California Department of Health Services, EPIC Branch Source: California Office of Statewide Health Planning and Development, Patient Discharge Data Homicide and Assaultive Injury Rates per 100,000 Women, by WeaponType, All Ages, California, 1992-1999 6 Rate per 100,000 5 4 3 2 1 0 Injuries Beating Firearms Knives Abuse and Neglect Prepared by California Department of Health Services, EPIC Branch Source: California Department of Health Services, Vital Statistics Death Statistical Master File; California Office of Statewide Health Planning and Development, Patient Discharge Data; California Department of Finance, Race/Ethnic Population with Age and Sex Detail Deaths Struck by Object Hospitalized Injuries Due to Assault by an Intimate Partner, by Sex, All Ages, California, 1997-1999 290 243 221 Males Females 23 1997 20 1998 29 1999 Prepared by California Department of Health Services, EPIC Branch Source: California Office of Statewide Health Planning and Development, Patient Discharge Data Possible Reasons IP Injuries Are Not Fully Reported in the Patient Discharge Data • Health care provider omission • Patient non-disclosure • Inaccurate or incomplete reporting Appropriate coding for Injuries Due to IPV • Child and adult abuse take precedence over all other codes • Use “adult abuse” code as the principal diagnosis code (995.8x), if this is a reason for admit • Use the most appropriate E-code to describe the injury as the principal E-code (E960-968) • Use E967.3 (or other relationship code) as a secondary E-code to describe the relationship between perp and victim Principal Diagnosis of Hospitalized Injuries Due to Assault by an Intimate Partner, Females Only , All Ages, California, 1996-1999 Percent of IPV injuries* 15.1 16.2 16.8 17.6 14.5 5.7 3.6 6 4.5 D ise M as en e ta ld iso rd er Pr eg na nc A y du lt ab us e od y H ea d bs bs ra lb pp er l *Principal E-code only Prepared by California Department of Health Services, EPIC Branch Source: California Office of Statewide Health Planning and Development, Patient Discharge Data C Lo w en t U er lim O th im er Child Maltreatment Injury Pyramid for California, 1998-2001 – CAN Fatalities (~125) – Serious and Severe Hospitalization (~500) – CAN Incidences (112,954) – Reported CAN (545,246) – Unreported Cases Prepared by DHS EPIC Branch from Reconciliation Audits, 1998, OSHPD Hospital Discharge Data, 2000, and Child Welfare Services Reports for California (8/15/02) http://cssr.berkeley.edu/CWSCMSreports/, 2001. Reporting of Child Maltreatment Hospitalizations, Age 0-17, 1997-2000 450 Correctly reported 1893 Not correctly reported 1443 Prepared by California Department of Health Services, EPIC Branch Source: California Office of Statewide Health Planning and Development, Patient Discharge Data Concluding Remarks • Data on IPV are available in the patient discharge data but value is limited due to underreporting • Need to improve the quality of discharge data coding to identify as many cases as possible. • Quality can be improved by – Better reporting – Better documentation