2026-03-31 スウォンジー大学
＜関連情報＞
- https://www.swansea.ac.uk/press-office/news-events/news/2026/03/nurse-led-programme-helps-prevents-violence-and-improves-emergency-care.php
- https://www.sciencedirect.com/science/article/pii/S2589537026000957
- https://www.researchprotocols.org/2026/1/e86247
英国における看護師主導の病院内暴力介入プログラムの準実験的有効性評価：日常的な健康データと管理データを連結して使用 A quasi-experimental effectiveness evaluation of a nurse-led Hospital Violence Intervention Programme in the United Kingdom using linked routine health and administrative data
Simon C. Moore, Sinead Brophy, Amrita Bandyopadhyay, Megan Hamilton, Henry Yeoman, Adele Battaglia, David O’Reilly, Lara Snowdon, Jonathan Shepherd, Danny Tod, Alan Watkins, Vas Sivarajasingam, Simon Walker, Shainur Premji
eClinicalMedicine Available online: 26 March 2026
DOI:https://doi.org/10.1016/j.eclinm.2026.103848
Summary
Background
Emergency Department (ED) care of people injured in violence is increasingly seen as an opportunity to address patients’ psychosocial vulnerabilities as well as their treatment. These vulnerabilities include alcohol, drug use, mental health and social vulnerabilities that are also associated with high levels of unplanned ED attendances for reasons other than violent injury. Since evidence of the effectiveness of interventions designed to reduce these risks is weak, we evaluated the impact of nurse-led Hospital Violence Intervention Programmes (HVIPs) across two sites in Wales, United Kingdom, on subsequent unplanned ED attendance.
Methods
We used anonymised country-wide electronic health and administrative data to identify a cohort of patients, from 2019 to 2024, injured in violence who attended EDs in Wales, United Kingdom. We matched the characteristics of patients who engaged with the HVIP to control patients in the same cohort. We estimated the unadjusted hazard ratio (HR) for subsequent unplanned ED attendances for patients, and adjusted HRs to determine HVIP effectiveness overall and for sub-groups based on age and gender. This study is registered with ISRCTN (68945844).
Findings
For patients who engaged with the intervention (n = 2068; representing 3580 attendances), the frequency of subsequent ED attendances was lower than control patients (n = 6196; 12,174 attendances; HR = 0.95, 95% CI 0.91–0.99). The intervention was more effective for female patients (HR = 0.86, 95% CI 0.80–0.92) and those aged 11–17 (HR = 0.88, 95% CI 0.82–0.92) and 18 to 30 (HR = 0.86, 95% CI 0.80–0.92) years of age.
Interpretation
If risk factors associated with violence related injury are identified and addressed as part of ED care, ED attendances can be reduced.
Funding
This study is funded by the National Institute for Health and Care Research, Public Health Research Programme (NIHR134055).
英国における救急外来を拠点とした暴力介入プログラムの有効性と費用対効果：準実験的研究のプロトコル Effectiveness and Cost-Effectiveness of Emergency Department–Based Violence Intervention Programs in the United Kingdom: Protocol for a Quasi-Experimental Study
Simon Moore; Sinead Brophy; Amrita Bandyopadhyay; Annemarie Newbury; Megan Hamilton; Adele Battaglia; Trudy Lowe; David O’Reilly; David Rawlinson; Lara Snowdon; Jonathan Shepherd; Vaseekaran Sivarajasingam; Alan Watkins; Simon Walker; Shainur Premji; Sophie Borgia; Henry Yeomans
JMIR Research Protocols Published: 21.Oct.2025
DOI:https://preprints.jmir.org/preprint/86247
Abstract
Background:Hospital-Based Violence Intervention Programs (HVIPs), based in Emergency Departments (EDs), have been proposed as a public health response to violence. These programs address the underlying reasons why patients are exposed to violence. In addressing any underlying modifiable risks and vulnerabilities HVIPs can reduce patients’ exposure to violence and therefore subsequent unplanned attendance into ED.
Objective:The objectives of this study are to (1) assess whether patient involvement with a HVIP reduces the likelihood of unscheduled ED reattendance, (2) determine whether the presence of the HVIP improves ascertainment of violence in ED attendances, and (3) derive the costs of the HVIP and compare those to the benefits of the intervention and understand whether the HVIP represents value for money from a health service perspective. If an effect is observed, then models will estimate the health impacts, costs and potential savings over a longer time (eg, 10 years) period and for a national roll-out.
Methods:ED patients are eligible for inclusion in the evaluation if they are normally resident in Wales, United Kingdom, aged 11 years and older. A controlled longitudinal natural experiment will be undertaken. The primary outcome is derived from the Emergency Department Dataset, routinely collected for all EDs in Wales, and is subsequent unplanned ED attendance. Case patients will be matched to control patients attending EDs without an HVIP. Analysis will derive the hazard rate for subsequent unplanned ED attendances using recurrent event analysis. The total monthly count of patients identified as attending because of violence in intervention EDs will be compared to the total count of Welsh control EDs in an interrupted time-series analysis to determine whether HVIPS increase violence ascertainment. To determine whether referral, versus no referral, to the HVIP represents value for money, we will undertake a cost-effectiveness analysis from the perspective of the National Health Service. The approval to access and analyze data housed in the Secure Anonymized Information Linkage (SAIL) databank, an ISO (International Organization for Standardization) 27001 certified and UK Statistics Authority accredited secure data environment, was granted by the SAIL independent Information Governance Review Panel (Ref: 1421). Findings will be presented at local, national, and international conferences and disseminated by peer-reviewed publication.
Results:Design inputs arising from public patient involvement and engagement (PPIE) are reported. As a protocol, no further results are available.
Conclusions:Novel methods are developed to provide the first robust evaluation of Emergency Department Violence Intervention Programs (EDVIPs).
Trial Registration:ISRCTN Registry ISRCTN68945844; https://www.isrctn.com/ISRCTN68945844?q=68945844&filters=&sort=&offset=1&totalResults=1&page=1&pageSize=10
International Registered Report Identifier (IRRID):PRR1-10.2196/86247
