Organizational and community determinants of hospital-based violence prevention programs in the United States

Hospital-based workplace violence prevention programs (WVPPs) and community violence prevention programs (CVPPs) are increasingly used to protect healthcare workers and respond to violence-related harm. National evidence on which hospitals report these programs remains limited. This study examined national patterns of annual WVPP and CVPP reporting in U.S. hospitals and identified organizational, financial, and community factors associated with reporting.

Retrospective longitudinal observational study.

We analyzed 13,876 hospital-year observations from 3358 nonfederal acute care hospitals between 2018 and 2022 using linked data from the American Hospital Association Annual Survey, the National Academy for State Health Policy Hospital Cost Report Tool, and the CDC/ATSDR Social Vulnerability Index (SVI). Population-averaged generalized estimating equation logistic regression models estimated associations between annual program reporting and hospital characteristics, including county socioeconomic vulnerability, with year fixed effects.

Across hospital-years, 66.8% reported a WVPP and 15.4% reported a CVPP. Nonprofit ownership, major teaching status, urban location, higher nurse staffing intensity, and larger hospital size were associated with higher odds of reporting both program types. Major teaching hospitals showed especially strong associations with WVPP (OR = 1.99, 95% CI 1.47-2.68) and CVPP (OR = 2.29, 95% CI 1.66-3.17) reporting. For WVPP, higher emergency department visits per bed were positively associated with reporting (OR = 1.25, 95% CI 1.14-1.36), whereas higher county socioeconomic vulnerability was negatively associated (OR = 0.62, 95% CI 0.48-0.80). County socioeconomic vulnerability was not significantly associated with CVPP reporting. Relative to 2018, the odds of reporting both programs increased over time.

Violence prevention reporting increased over time but remained uneven across hospital types. WVPPs were far more common than CVPPs, and both were concentrated in hospitals with greater organizational capacity. Targeted policy and implementation support may be needed to expand prevention infrastructure in lower-resourced settings.