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: 10699982
• 负责人: Stacie Luther Daugherty
• 金额: $ 79.14万
• 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/10699982
• 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; Eligibility Determination; 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; Research Methodology; Services; Structural Racism; System; Testing; Visit; Writing; access disparities; behavioral health; cardiovascular health; cardiovascular risk factor; care outcomes; cohort; community organizations; follow-up; health assessment; health care availability; health care quality; health care service organization; health care service utilization; health disparity; housing instability; improved; innovation; mortality; multidisciplinary; peer; people of color; poor health outcome; 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.

项目摘要/摘要 种族主义、种族隔离和刑事司法实践的社会制度导致了很高的 监禁黑人、土著和其他有色人种(BIPOC)，代表结构性种族主义和 歧视(SRD)。出狱后，人们面临着受SRD影响的进一步挑战，包括 保健系统中限制获得机会并导致健康状况不佳的政策、程序和做法。 与普通人群相比，出狱人员的简历健康状况不佳的比例更高。 心血管事件的风险增加，出院2年内心血管(CV)死亡率更高。进入 出狱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没有对SRD进行系统调查，以及在多大程度上 不同的组织政策和做法限制或延续了获得机会和健康成果方面的差异 从监狱获释的人中有多少人尚不清楚。我们提出了三个具体目标来提供关键信息 关于医疗保健组织中的SRD，并开始解决这个问题。在目标1中，使用三种不同的健康 系统，我们将分析系统书面材料，并与系统进行访谈和焦点小组 领导、前线工作人员和社区组织的代表，以衡量政策和做法 以及对医疗保健可获得性、过渡计划、文化、对健康的社会决定因素的支持的态度 以及为出狱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)，我们将预期招收600名最近获释的人 从监狱进入纵向队列研究，以评估他们对医疗保健结构条件的暴露 在发布之后。使用所有付款人索赔数据库，我们将检查暴露于 医疗保健利用的结构状况和12个月的初步结果(诊所就诊、紧急就诊、 住院)和CV住院和全因死亡率的次要结果。种族/民族和 基线心血管健康状况将作为调节变量进行检查，因为横断面SRD可能特别 BIPOC的劣势个人从监狱释放和那些简历健康状况不佳的人。在《目标3》中，我们将 整合目标1和目标2的结果，以制定实践建议，以改善医疗保健的可及性和 从监狱释放的人的结果。建议将与社区一起反复修改 咨询委员会，并使用修改后的德尔福国家专家小组进行了最后敲定。最终建议将是 集结并广泛传播。考虑到人口数量巨大，有 监禁，他们健康状况不佳的沉重负担，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 改善出狱人员的获取途径和健康状况。解决消极因素带来的重大问题 监禁和SRD的健康后果需要在多个层面上了解结构状况。