Measuring Total Healthcare Utilization Among Intimate Partner Violence Survivors In Primary Care

Rising health care costs are influenced by health care utilization, which encompasses hospital, ambulatory and non-face-to-face episodes of care. In this study, we created a novel a health care utilization-scoring tool that was used to examine whether one psychosocial factor, intimate partner violence (IPV), leads to higher utilization of health care services when controlling for relevant confounders. We sought to fill gaps about how social and behavioral issues impact utilization, particularly non-face-to-face episodes of care. We conducted a retrospective cross-sectional study in 2017 examining patients seen at 11 University-affiliated primary care clinics from January 2015 to December 2016 who were screened for IPV. A total of 31,305 patients were screened, of which 280 screened positive. We controlled for medical complexity by deriving the revised Charlson Comorbidity Index for each patient. We calculated a novel utilization score, which was a weighted sum of hospital, ambulatory and non-face-to-face encounters. Missed appointments were also measured. IPV-positive and IPV-negative patients were similar with respect medical complexity. IPV-positive patients had significantly higher mean utilization scores (54 vs. 40, p<0.001) and more missed appointments (3 vs. 1.3, p<0.001). IPV was associated with increased total utilization (p=0.015), as well as non-face-to-face and ambulatory visits (p=0.025 and p=0.015, respectively) for female patients and was associated with more missed appointments for both males and females (p<.001). These data support more inclusive population-specific interventions focusing on social determinants of health to reduce both face-to-face and non-face-to-face utilization, which may improve health care expenditures, outcomes and provider satisfaction.