Health systems innovations for supporting transitions of care for incarcerated people living with HIV, hepatitis C and opioid use disorder

项目概要/摘要 最近被监禁的成年人因阿片类药物过量而死亡的风险很高，并经常报告艾滋病毒/HCV 传播风险行为，使他们成为卫生系统干预措施的高度优先群体， 改善对初级保健的参与和对循证预防和治疗服务的利用。 该项目将全面评估监禁后的医疗保健利用和结果， 通过将来自大型监狱的患者水平数据联系起来，对患有阿片类药物使用障碍、HIV和HCV的收入居民进行了研究 系统和医疗补助登记和索赔记录的美国中西部国家，已严重 受阿片类药物流行的影响然后，整合后的数据将用于追求三个互补 研究目的：1）确定影响使用一般药物的个体水平特征和合并症 2）评估慢性病患者从监狱释放后的门诊护理; 系统级干预的影响，促进预释放医疗补助登记，对使用后释放 门诊护理; 3）适应和评估低成本，循证的可行性和可接受性 过渡性护理计划，称为C-TraC，用于增加对监禁人员的门诊医疗服务 HIV、HCV和/或阿片类药物使用障碍。我们提出了一种混合方法的方法，基于复制 有效计划（REP）实施理论模型，以适应基于电话的，护士主导的情况 管理干预（C-TraC）的惩教保健设置。通过与主要利益攸关方的访谈 和焦点小组，我们将引出被监禁的病人，惩教人员和 管理人员和监狱的社会服务和卫生服务提供者，以制定一个适应的C- TraC协议反映了当地定义的目标和结果。C-TraC方案的执行情况 国家监狱系统将通过几个快速周期改进阶段，使利益攸关方- 驱动修改，旨在优化对核心方案步骤的保真度并实现目标结局。 这种协议化的实现方法，以及通过该项目创建的新数据资源， 将使我们的团队能够确定最佳的目标人群、人员配置要求和相关成本， 将C-TraC传播到其他监狱系统所需的初步健康影响措施， 并进行临床试验以正式评估其有效性。如果发现在这种情况下有效， 过渡性护理干预措施，如C-TraC，可以通过促进获得机会，对公共卫生产生深远影响 为美国最脆弱的人群之一提供基于证据的阿片类药物治疗。

PROJECT SUMMARY / ABSTRACT Recently incarcerated adults have a high risk of death from opioid overdose and frequently report HIV/HCV transmission risk behaviors, making them a high priority group for health system-based interventions aimed at improving engagement in primary care and utilization of evidence based prevention and treatment services. This project will comprehensively evaluate post-incarceration health care utilization and outcomes for low- income residents with opioid use disorder, HIV and HCV by linking patient-level data from a large prison system and Medicaid enrollment and claims records for a Midwestern U.S. state that has been heavily impacted by the opioid epidemic. The integrated data will then be used to pursue three complementary research aims: 1) To identify individual-level characteristics and comorbidities influencing use of general outpatient care by people with chronic health conditions after they are released from prison; 2) To assess the impact of a systems-level intervention, facilitated pre-release Medicaid enrollment, on the use of post-release outpatient care; and 3) To adapt and evaluate the feasibility and acceptability of a low cost, evidence based transitional care program, called C-TraC, for increasing use of outpatient medical care for incarcerated people with HIV, HCV and/or opioid use disorder. We propose a mixed-methods approach, based on the Replicating Effective Programs (REP) Implementation Theory Model, to adapt a telephone-based, nurse-led case management intervention (C-TraC) for the correctional health care setting. Through key stakeholder interviews and focus groups, we will elicit the perspectives of incarcerated patients, correctional officers and administrators, and prison-based social service and health service providers, in order to develop an adapted C- TraC protocol reflective of locally defined goals and outcomes. Implementation of the C-TraC program across the state prison system will proceed through several rapid-cycle improvement phases, resulting in stakeholder- driven modifications designed to optimize fidelity to core protocol steps and achievement of targeted outcomes. This protocolized implementation approach, together with the novel data resource created through this project, will allow our team to define the optimal target population, staffing requirements and associated costs, and preliminary measures of health impact that will be needed to disseminate the C-TraC to other prison systems, and to conduct a clinical trial to formally assess its effectiveness. If found to be effective in this setting, transitional care interventions such as C-TraC could have a profound public health impact by promoting access to evidence-based opioid treatment for one of the most vulnerable populations in the U.S.