“The problem now is we really don’t have evidence to know what’s effective and what works” to prevent gun-related injury, said David Grossman, a doctor and senior researcher who will help lead the new task force.
Kaiser Permanente decided to jump-start its effort because of the huge effect of gun violence on its patients. The health system has more than 12 million member patients across the country, and between 2016 and 2017, its doctors treated more than 11,000 gunshot wounds.
“This is something that affects us and our patients directly,” said Bechara Choucair, the system’s chief community health officer and a doctor. “We should be thinking about this problem and studying interventions for it in the same way we study heart disease or diabetes or any other leading cause of death.”
The announcement coincides with a resurgence of gun-control activism — led by the student survivors of the February mass shooting in Parkland, Fla. — as well as with new actions by retailers to limit sales of military-style rifles and high-capacity guns and increased research interest from private foundations and state governments.
Scientists who study gun violence and injury said Kaiser Permanente’s decision is a significant development in their world, given the health system’s institutional resources and data, not to mention the money.
“In some fields like cancer research, $2 million may seem like small change. ... But in gun research, where there is almost no money at all, this is big,” said David Hemenway, director of the Harvard Injury Control Research Center.
By comparison, the annual budget for gun-violence research at the Centers for Disease Control and Prevention was $2.6 million in 1996. That was the year Congress passed a rule essentially killing almost all federal funding for such work. The rule, known as the Dickey Amendment, was backed by the National Rifle Association and remains in place.
On Capitol Hill, language accompanying last month's $1.3 trillion spending bill clarified that the CDC can conduct research on gun violence. But that wording did not address the Dickey Amendment, and Congress did not restore any federal funding for that research.
Kaiser Permanente officials said they will use the initial $2 million to identify what new studies and data would help most and what interventions its doctors and hospitals could adopt to reduce gun deaths and injury.
The size of Kaiser’s system and its role as a primary health provider presents a unique chance for research, said Garen Wintemute, a leading gun-violence researcher at the University of California at Davis. “Their detailed patient data allow them to conduct research that simply can’t be performed in other settings. One possibility: Kaiser would be an ideal setting for research on how best to integrate firearm violence prevention into patient care.”
The research could help Kaiser figure out which patients are at high risk and design protocols to try to steer them from potential gun violence, officials said.
For example, the majority of U.S. gun deaths are from suicides. Kaiser patients who go in for annual checkups are already asked whether they have had recent thoughts of suicide. If they answer yes, they are asked additional questions to try to determine their degree of intent. New research could guide doctors on other steps to help such patients or those caring for them to limit access to guns while they are struggling with suicidal thoughts.
Other hospitals have also experimented in recent years with integrating research and interventions to reduce gun violence among gangs. Some have adopted new protocols to try to prevent gunshot victims who are admitted for care from being a target again or from becoming perpetrators themselves in retaliation shootings.
Kaiser’s new task force will pull together clinicians and researchers to identify main priorities for research and then award funding toward such studies. The dollars will primarily go toward research done within Kaiser but will probably involve collaboration with external researchers as well, according to officials. A main goal, they said, is to start building institutional expertise on gun violence and a foundation for research.
Officials said they plan to make public their research and the interventions developed. “This is our first step in helping us as a system to see what we can contribute,” Choucair said. “We’re hoping this will be a catalyst for others to start being engaged in this space as well.”