Violence and Abuse Prevention (Intimate Partner/ Sexual)

Magnitude of the Problem

Intimate partner violence is well known to be under-reported (under-coded) in administrative medical records. The reliability of describing this issue through sources such as hospital billing data is therefore in question. Analysis of such data from 2015 through 2017 indicated an average of 125 hospital presentations of injuries from IPV against women each year. This number could be increased to approximately 200 if records with no information on perpetrator are also included. Most (92%) of these injuries were treated at the emergency department level. The proportion of patients residing in Oahu (54%) was lower than expected, given 69% of female residents 12 years and older reside there. Conversely, 28% of the patients were from Hawaii County, which accounts for only 14% of the female population.

To examine this issue in the pre-hospital setting, a random sample of 855 (18%) of the 4,777 Emergency Medical Services records for females (ages 12 to 50 years) who were injured by assaults from 2013 through 2015. Based on open text narrative from the EMS provider, IPV was identified as the “definite” cause of 38% of the injuries, and the “probable” or “possible” cause of 21%. These proportions result in annual estimates of 609 definite EMS encounters of IPV each year, and an additional 340 probable/possible incidents. Nearly two-thirds (65%) of the EMS patients refused transport to a hospital for further medical attention. Even so, the estimated average of 330 EMS transports of female victims of IPV exceeds that indicated from hospital billing data (125), confirming the under-coding of IPV in hospital records. Based on a study of Hawaii EMS records linked to hospital records, only 39% of female IPV hospital patients arrive by EMS. Combined with the 330 who are transported by EMS, the annual estimate of hospital presentations of IPV is 800 to 900.

The average age of the IPV victims was 31 years, and 75% were 20 to 40 years of age. Victim age distribution was similar across counties. Overall 66% of the patients refused hospital transport. This proportion was significantly lower for those treated in Hawaii County (23%) compared to other counties (71%). There was no association between victim age and transport status.

Recommended Strategies

The EMSIPSB places a priority on having injury prevention strategies recommended by a community-driven action plan or informed by key implementing partners. Because a multitude of factors influence individual behavior, the strategies in the below table are framed across the individual, relationship, community, and policy levels.

Table by Visualizer

Key Partners