Paying the Price: The Pressing Need for Quality, Cost, and Outcomes Data to Improve Correctional Health Care for Older Prisoners
Paying the Price: The Pressing Need for Quality, Cost, and Outcomes Data to Improve Correctional Health Care for Older Prisoners
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DOI：
10.1111/jgs.12510
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发表时间：
2013-11-01
影响因子：
6.3
通讯作者：
Williams, Brie A.
中科院分区：
文献类型：
--
作者：
Ahalt, Cyrus;Trestman, Robert L.;Williams, Brie A.
尽管美国监狱人数最近有所下降，但老年囚犯人数正在迅速增长。美国宪法要求监狱为囚犯提供医疗保健。随着人口老龄化，医疗成本上升，各州被迫削减支出，许多惩教机构难以达到这一法定护理标准。老年囚犯现在占监狱人口的近10%，如果不能满足他们的医疗需求，可能会在医疗脆弱的人群中造成本可以避免的痛苦，并违反宪法规定的在监禁期间及时获得适当水平护理的规定。无法在监狱中获得适当医疗保健的老年囚犯也影响到社区医疗系统，因为95%以上的囚犯最终被释放，其中许多人被送往城市社区，那里的医疗保健差距很常见，急性医疗保健资源被过度使用。缺乏统一的质量和成本数据严重阻碍了政策和做法的创新，以提高惩教保健的价值(以可持续的成本实现预期的健康结果)。凭借其在复杂的慢性病管理方面的独特知识，老年医学专家能够帮助解决惩教卫生保健中的老龄化危机。本文描述了老年医生和老年病学家应对这一危机所需的基本健康、成本和结果数据，确定了现有数据中的差距，并预测了数据收集的障碍，如果解决这些障碍，可以使临床医生和政策制定者评估和改善老年监狱卫生保健的价值。
Despite a recent decline in the U.S. prison population, the older prisoner population is growing rapidly. U.S. prisons are constitutionally required to provide health care to prisoners. As the population ages, healthcare costs rise, states are forced to cut spending, and many correctional agencies struggle to meet this legal standard of care. Failure to meet the healthcare needs of older prisoners, who now account for nearly 10% of the prison population, can cause avoidable suffering in a medically vulnerable population and violation of the constitutional mandate for timely access to an appropriate level of care while incarcerated. Older prisoners who cannot access adequate health care in prison also affect community healthcare systems because more than 95% of prisoners are eventually released, many to urban communities where healthcare disparities are common and acute healthcare resources are overused. A lack of uniform quality and cost data has significantly hampered innovations in policy and practice to improve value in correctional health care (achieving desired health outcomes at sustainable costs). With their unique knowledge of complex chronic disease management, experts in geriatrics are positioned to help address the aging crisis in correctional health care. This article delineates the basic health, cost, and outcomes data that geriatricians and gerontologists need to respond to this crisis, identifies gaps in the available data, and anticipates barriers to data collection that, if addressed, could enable clinicians and policy-makers to evaluate and improve the value of geriatric prison health care.