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

项目摘要/摘要 最近被监禁的成年人死于阿片类药物过量的风险很高，并经常报告艾滋病毒/丙型肝炎病毒 传播危险行为，使他们成为以卫生系统为基础的干预措施的高度优先群体 改善初级保健的参与度和循证预防和治疗服务的利用。 该项目将全面评估监狱服刑后的卫生保健利用情况和结果。 通过连接来自大型监狱的患者水平数据，获得患有阿片类药物使用障碍、艾滋病毒和丙型肝炎的收入居民 美国中西部一个州的系统和医疗补助登记和索赔记录 受阿片类药物泛滥的影响。然后，综合数据将被用来寻求三个互补 研究目标：1)确定影响一般药物使用的个体水平特征和共病 慢性疾病患者出狱后的门诊服务；2)评估 系统层面的干预，促进了出院前的医疗补助登记，对出院后使用的影响 门诊护理；以及3)适应和评估基于证据的低成本的可行性和可接受性 过渡护理计划，称为C-TRAC，旨在增加对被监禁者的门诊医疗护理 患有艾滋病毒、丙型肝炎病毒和/或阿片类药物使用障碍。我们提出了一种基于复制的混合方法 有效计划(REP)实施理论模型，以适应以电话为基础、由护士主导的病例 惩教卫生保健环境的管理干预(C-TRAC)。通过与关键利益相关者的访谈 和焦点小组，我们将引导被监禁患者、惩教人员和 管理人员以及监狱社会服务和保健服务提供者，以便制定一种适应的C- 反映当地定义的目标和结果的跟踪协议。跨区域实施C-TRAC计划 州监狱系统将经历几个快速循环的改进阶段，从而产生利益相关者-- 推动修改，旨在优化对核心议定书步骤的忠诚度，并实现目标结果。 这种协议化的实现方法，加上通过这个项目创建的新的数据资源， 将使我们的团队能够定义最优的目标人口、人员需求和相关成本，以及 向其他监狱系统传播C-TRAC所需的健康影响的初步措施， 并进行临床试验，正式评估其疗效。如果发现在此设置中有效， 过渡性护理干预措施，如C-TRAC，可以通过促进获得 为美国最脆弱的人群之一提供循证的阿片类药物治疗。

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.