Interpreting the Affordable Care Act, other Federal Healthcare Policies and Hospital Missions to Improve the Surveillance of Violence

Background: Surveillance of community violence and population-based prevention strategies can be achieved utilizing clinical practice and healthcare policies. Data collected in emergency departments (EDs), including location of violence and weapon, has policy and intervention implications (e.g., Cardiff Model). We describe collection of violence data in four EDs using institutional and federal healthcare policy interpretations to convert violence data collection from a research activity to a best clinical practice.

Methods: Data collection is integrated into electronic health records (EHRs) at various points of service delivery in four EDs in a Midwestern metropolitan area. To inform ED collection methods, project and hospital leaders discuss violence surveillance in the contexts of clinical care, population health, institutional missions, and federal healthcare policies like the Affordable Care Act (ACA) and from the Centers for Medicare and Medicaid (CMS).

Results: We describe our interpretation of the ACA’s population health principles, CMS incentive programs for meaningful use of EHRs, and health systems’ institutional missions and community outreach objectives to initiate data collection outside of a research context. This framework shifted research questions from methods of data collection to data utilization for violence prevention. Three hospitals quickly connected data collection with their missions and federal health care policy and engaged in non-research, hospital-based initiatives. One hospital is still exploring how to integrate data collection into its workflow.

Conclusions: Within a public health approach, healthcare systems have opportunity to utilize institutional and federal policies to improve local surveillance. This approach may enhance community surveillance for and prevention of violence.