Paul B. Hofmann, DrPH, LFACHE
By Topic: Delivery of Care Population Health By Collection: Blog
The role of hospitals in improving population health is well known. Too often, however, there are missed opportunities.
According to a May 10, 2018, study published in the Journal of Urban Health, an estimated 4.6 million American children reside in a household where at least one gun is kept loaded and unlocked. The study’s authors alsodetermined that the share of child-rearing gun owners who don’t secure all their firearms had nearly tripled since the last time similar research was conducted.
In June, U.S. Surgeon General Vivek Murthy, MD, issued an advisory declaring firearm violence a public health crisis, an important step at the national level. But what can be locally? As I wrote in a June 10, 2022, blog post for the American Hospital Association, a number of healthcare organizations have taken initiatives to address firearm violence, but active engagement is needed by more health systems and hospitals already committed to improving community health status. Here are three examples of what that could look like.
- Replicate the actions of the University of Maryland Medical Center violence prevention program, which lowered participants’ reinjury rates to as little as 5%. This program was initiated in recognition that those with a history of violent injury are usually 45% more likely to be readmitted with another such injury within five years. The services provided by the violence prevention program at Shock Trauma include peer support groups, individual counseling and advocacy, GED diploma assistance, job readiness and training, parole and probation service, connections to community resources and protective/peace order filing assistance.
- Consider steps taken by Temple University Hospital, which treated more than 850 shooting victims in 2021, the highest number of any Level I trauma center in Pennsylvania. The hospital:
a. Used its Fighting Chance program to teach community members how to provide basic first aid to victims of gunshot wounds.
b. Developed a plan focused on at-risk youth to help break the cycle of gun violence.
c. Instituted “The Turning Point” intervention program to take advantage of teachable moments that exist during the post-injury/pre-discharge period for survivors of violence.
d. Created the Safe Bet Program to prevent unintentional childhood shooting. Safe Bet has provided more than 8,000 gun locks to Philadelphia families. In an effort to prevent unintentional shootings, Temple University Hospital’s program offers free cable gun locks—no questions asked—to Philadelphia families who have small children and firearms.
- Review the extensive literature on gun violence prevention programs at health systems and hospitals to determine which components can be instituted in your organization.
For example, the BulletPoints Project in California provides resources that help clinicians learn how to discuss firearms with patients and how to communicate with those who are at risk of gun violence. Funded by the state of California, the project emerged from the violence prevention research of Amy Barnhorst, MD, a psychiatrist at UC Davis Health, to provide training for clinicians to help them understand what they can do to prevent gun violence.
The need to reduce gun violence is unrelated to the fact that the number of guns exceed the country’s total population or that U.S. gun production has tripled since 2000, fueled largely by handgun purchases.
From the perspective of healthcare providers, the most critical issue is what more can be done at the local level. For example, the Health Alliance for Violence Intervention “supports an intervention community of violence intervention specialists, doctors, health administrators and researchers providing resources to enhance new and existing network programs.” HAVI’s efforts include the Coalition to Advance Public Safety announcing that $2 million would be provided to community violence intervention programs in four cities to reduce gun violence by 15%. Programs in Atlanta, Los Angeles, Milwaukee and Oakland, Calif., will receive on-the-ground support and up to $500,000 in grant funding per jurisdiction to develop strategies.
Hospitals have the opportunity and responsibility to address the intersectional nature of trauma, social determinants of health and violence. Any initiative to promote gun safety is a vital step in the right direction.
Paul B. Hofmann, DrPH, LFACHE, is president of the Hofmann Healthcare Group, Moraga, Calif., and co-editor of Managing Healthcare Ethically: An Executive’s Guide, published by Health Administration Press, and Management Mistakes in Healthcare, published by Cambridge University Press.
