Healthcare Organizational Structural Conditions and the Health of People Recently Released from Prison

医疗卫生组织结构状况与刑满释放人员健康状况

• 批准号: 10473182
• 负责人: Stacie Luther Daugherty
• 金额: $ 79.05万
• 依托单位: KAISER FOUNDATION RESEARCH INSTITUTE
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-09-07 至 2027-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10473182
• 关键词: Address; Adult; Affect; Area; Attitude; Black Populations; Black race; Cardiology; Cardiovascular Diseases; Cardiovascular system; Clinic Visits; Colorado; Communities; Criminal Justice; Data; Databases; Disadvantaged; Discrimination; Emergency Situation; Employment; Enrollment; Ethnic Origin; Event; Exposure to; Face; Focus Groups; Frontline worker; Future; General Population; Goals; Health; Health Services Accessibility; Health system; Healthcare; Healthcare Systems; High Prevalence; Hospitalization; Housing; Imprisonment; Improve Access; Indigenous; Individual; Intervention; Interview; Investigation; Link; Longitudinal cohort study; Measures; Medicaid; Observation in research; Organizational Policy; Outcome; Patients; Persons; Policies; Population; Prisons; Procedures; Race; Recommendation; Recording of previous events; Research; Services; Social support; Structural Racism; System; Testing; Time; Visit; base; behavioral health; cardiovascular health; cardiovascular risk factor; care outcomes; cohort; follow-up; health care availability; health care quality; health care service organization; health care service utilization; health disparity; housing instability; improved; innovation; mortality; multidisciplinary; neighborhood safety; peer; people of color; prevent; primary outcome; programs; prospective; racial disparity; racism; safety net; secondary outcome; segregation; social health determinants; social stigma

PROJECT SUMMARY/ABSTRACT Societal systems of racism, segregation, and criminal justice practices have resulted in high rates of imprisonment of Black, Indigenous, and other People of Color (BIPOC) and represent structural racism and discrimination (SRD). Upon release from prison, people face further challenges influenced by SRD including policies, procedures and practices in the healthcare system that limit access and contribute to poor health. Compared to the general population, people released from prison have a higher prevalence of poor CV health, an increased risk of CV events, and higher cardiovascular (CV) mortality within 2 years of release. Access to healthcare following release from prison is key to preventing poor health outcomes in this population. Systematic investigation of SRD in diverse healthcare systems has not occurred, and the extent to which different organizational policies and practices limit or perpetuate disparities in access and health outcomes among people released from prison is unknown. We propose three specific aims to provide critical information on SRD in healthcare organizations and begin to address the problem. In Aim 1, using three diverse health systems, we will analyze system written materials and conduct interviews and focus groups with system leaders, frontline staff, and representatives of community-based organizations to measure policies, practices and attitudes around healthcare access, transition programs, culture, support of social determinants of health and specialized services for people released from prison. In Aim 2, leveraging a database of individuals released from Colorado state prisons (~400 a month), we will prospectively enroll 600 people recently released from prison into a longitudinal cohort study to assess their exposure to healthcare structural conditions following release. Using the all-payer claims database, we will examine the association between exposure to structural conditions and 12-month primary outcomes of healthcare utilization (clinic visits, emergency visits, hospitalization) and secondary outcomes of CV hospitalization and all-cause mortality. Race/ethnicity and baseline CV health will be examined as moderating variables because intersectional SRD may particularly disadvantage BIPOC individuals released from prison and those with poor CV health. In Aim 3, we will integrate results from Aims 1 and 2 to develop practice recommendations to improve health care access and outcomes for people released from prison. Recommendations will be iteratively revised with a community advisory board and finalized using a modified Delphi panel of national experts. Final recommendations will be assembled and broadly disseminated. Given the enormity of the population of individuals with a history of imprisonment, their significant burden of poor health including CV disease and the disproportionate imprisonment of BIPOC individuals, a critical goal of our research is to identify targets for future interventions to improve access and health for people released from prison. Solutions to the significant problem of negative health consequences to imprisonment and SRD requires understanding structural conditions at multiple levels.

项目总结/摘要 种族主义、种族隔离和刑事司法做法的社会制度导致了高比例的 监禁黑人，土著和其他有色人种（BIPOC），代表结构性种族主义， 歧视（SRD）。从监狱释放后，人们面临着受SRD影响的进一步挑战，包括 卫生保健系统中限制获得服务和导致健康状况不佳的政策、程序和做法。 与普通人群相比，从监狱释放的人有更高的CV健康状况不佳的患病率， 心血管事件风险增加，释放后2年内心血管（CV）死亡率较高。获得 从监狱释放后的医疗保健是防止这一人群健康状况不佳的关键。 在不同的医疗保健系统中，尚未对SRD进行系统研究， 不同的组织政策和做法限制或延续了获得和保健成果方面的差距 从监狱释放出来的人是未知的。我们提出了三个具体目标，以提供关键信息 并开始着手解决这一问题。在目标1中，使用三种不同的健康 系统，我们将分析系统的书面材料，并进行访谈和焦点小组与系统 领导人、一线工作人员和社区组织的代表，以衡量政策、做法、 以及对医疗保健获取、过渡计划、文化、健康社会决定因素的支持的态度 以及为刑满释放人员提供的专门服务。在目标2中，利用个人数据库 从科罗拉多州监狱释放（每月约400人），我们将前瞻性地招募600名最近释放的人 从监狱到纵向队列研究，以评估他们对医疗保健结构条件的暴露 释放后。使用所有付款人索赔数据库，我们将研究暴露于 结构状况和12个月的医疗保健利用的主要结果（诊所就诊，急诊就诊， 住院）和CV住院和全因死亡的次要结局。种族/民族和 基线CV健康将作为调节变量进行检查，因为交叉SRD可能特别 从监狱释放的BIPOC个人和那些CV健康状况不佳的人。在目标3中，我们 综合目标1和目标2的成果，制定实践建议，以改善获得保健的机会， 从监狱释放出来的人。建议将与社区一起反复修订 咨询委员会，并利用修改后的德尔菲国家专家小组最后确定。最终建议将是 收集并广泛传播。考虑到有犯罪史的人的数量， 监禁，他们的健康状况不佳，包括心血管疾病和不成比例的 监禁BIPOC个人，我们研究的一个关键目标是确定未来干预的目标， 改善从监狱释放出来的人的机会和健康。解决消极的重大问题 健康后果的监禁和SRD需要了解多层次的结构条件。