Medical care utilization patterns in women with diagnosed domestic violence.
BACKGROUND
Information on women with domestic violence (DV) suggests increased healthcare utilization across all levels of care and many diagnoses. In the present ancillary study (1997-2002), derived from a large, group-randomized intervention trial we conducted in a staff-model health maintenance organization (HMO) (1995-1998), we examined total and incremental utilization rates, costs, and patterns for women aged >/=18 years with DV identified through the record reviews conducted for the trial. By the choice of comparison groups used, our present aim was to "bracket" any associated increase in utilization.


METHODS
We compared visits and costs of medical-record confirmed cases of DV (n =62) to those for women without evidence of DV in the record (n =2287). These two groups were derived from women making visits for any one of four index reasons (injury, chronic pelvic pain, depression, or physical examination) associated with higher risk of DV or higher likelihood of its discussion. We constructed a second comparison group (n =6032) from the general population of enrolled women. We used the Chronic Disease Score to adjust for comorbidity.


RESULTS
After adjusting for comorbidity, we found a 1.6-fold higher rate of all visits (95% confidence interval [CI]=1.4-1.9) and 1.6-fold higher estimated costs (95% CI=1.3-2.0) for abused women compared to non-DV women. The rates were 2.3-fold higher when compared to all enrolled women.


CONCLUSIONS
Women with medical-record-documented DV demonstrate a pattern of increased utilization and costs across all levels of care and types of diagnoses. We conclude that being a DV case-patient is associated with between 1.6- and 2.3-fold increases in total utilization and costs.
Ulrich
Yvonne C
YC
School of Nursing, University of Washington, Seattle, Washington, USA.
Cain
Kevin C
KC
Sugg
Nancy K
NK
Rivara
Frederick P
FP
Rubanowice
David M
DM
Thompson
Robert S
RS
D000328:Adult; D002908:Chronic Disease; D015897:Comorbidity; D016001:Confidence Intervals; D017579:Domestic Violence / Q000706:statistics & numerical data*; D005260:Female; D006296:Health Services / Q000191:economics / Q000706:statistics & numerical data*; D006801:Humans; D008499:Medical Records; D008875:Middle Aged; D014861:Washington