Health Services Research, Prisons, Delivery of Health Care, Vulnerable Populations, Community Health Aides Clinical Trial
Official title:
The Impact of Parolee-Targeted Care Versus Expedited Usual Care on Health Care Utilization and Recidivism
The purpose of this study is to study the effectiveness of the Transitions Clinic, a
post-release clinic for parolees with chronic medical conditions, in achieving increased
primary care engagement, lower rates of inappropriate hospitalizations, psychiatric
emergency service and emergency department use, and decreased recidivism.
We hypothesize that subjects receiving parolee-targeted care in the Transitions Clinic will
have increased rates of non-emergency department ambulatory care and outpatient mental
health care, lower rates of hospitalization, psychiatric emergency service (PES)
utilization, emergency department (ED) utilization, decreased total hospital length of stay,
and decreased recidivism compared to patients receiving primary care from other safety-net
providers.
With ever increasing numbers of released inmates, policymakers are developing policy
initiatives and directing funding towards community reentry programs for recent parolees to
decrease recidivism and improve health outcomes. These reentry programs are comprehensive
efforts that coordinate social and medical services for recently incarcerated people to
achieve these aims. Due to documented poor health outcomes in this population and the
resultant costs on the public health system, provision of medical care will be an integral
part of these reentry initiatives. The manner in which medical care is incorporated into
community reentry programs and directed to recently released prisoners needs to be studied
to guide architects of reentry programs, policymakers and allocation of funding.
The Transitions Clinic (TC) was founded to address the medical needs of recently released
prisoners. The TC is a pilot project designed to target primary care medical services to
parolees in San Francisco and aid in coordination of medical and social services. It
operates within the San Francisco Department of Public Health(SFDPH)-affiliated Community
Health Network (CHN) and is part of the Safe Communities Reentry Council, a city-wide,
collaborative effort of the Sheriff's office, Public Defenders' office and local community
organizations to improve reentry services and outcomes for the 1500 annual parolees to San
Francisco.
The proposed project will prospectively examine the effectiveness of the TC in achieving
increased primary care engagement, decreased acute health care utilization and decreased
recidivism. After intake in the TC, patients will be randomized to continued,
parolee-targeted care in TC versus referral to safety net medical providers for non-targeted
care. We believe that the results of the study will assist policymakers by improving our
understanding of the:
1. effect of targeted and non-targeted medical care provision to post-release prisoners on
primary care engagement and utilization
2. effect of targeted and non-targeted medical care provision to post-release prisoners on
inpatient hospitalizations and emergency room and psychiatric emergency service
utilization.
3. effect of targeted and non-targeted care provision to post-release prisoners on
recidivism
4. costs for provision of targeted versus non-targeted medical care to post-release
prisoners (Do we want to do a cost analysis?)
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Allocation: Randomized, Endpoint Classification: Efficacy Study, Intervention Model: Parallel Assignment, Primary Purpose: Health Services Research