Physician use of diagnostic codes for child and adult abuse

Abstract

Objective: To report on physician use of diagnostic codes for child and adult abuse according to national medical care utilization data.

Methods: Secondary data analysis was performed on the National Ambulatory Medical Care Survey (NAMCS) of office-based physician visits and the National Hospital Ambulatory Medical Care Survey (NHAMCS) of visits to hospital emergency and outpatient departments for 1993 to 1996. Both databases describe physician, patient, and visit characteristics, and variables include up to three diagnoses per visit.

Results: Only 93 diagnoses of child or adult abuse were coded for 351,359 patient visits during the four years. As we would expect, child abuse was diagnosed more often than adult abuse (67 v 26), and the majority of cases (n = 57) were visits to emergency departments.

Conclusion: Diagnostic codes for abuse are not often used. Because these codes represent an important tool for reporting the prevalence and incidence of abuse, such documentation could lead to greater support for health care policies and resource allocation for victims of abuse. Lack of awareness about the diagnostic codes for abuse may be one explanation for underuse, but other barriers are also discussed.