Propensity-matched study of enhanced primary care on contact with the criminal justice system among individuals recently released from prison to New Haven

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Abstract

Background

Health systems can be integral to addressing population health, including persons with incarceration exposure. Few studies have comprehensively integrated state-wide data to assess how the primary care system can impact criminal justice outcomes. We examined whether enhanced primary care can decrease future contact with the criminal justice system among individuals just released from prison.

Methods

We linked administrative data (2013–2016) of Connecticut Department of Correction, Department of Mental Health and Addiction Services, Department of Social Service, Court Support Services Division, and Department of Public Health to conduct a quasi-experimental study using propensity score matching of 94 participants who received enhanced primary care in Transitions Clinic to 94 controls not exposed to the programme. The propensity score included 23 variables, which encompassed participants’ medical and incarceration history and service utilisation. The main outcomes were reincarceration rates and days incarcerated in the first year from the index date, which was either enrolment in the Transitions Clinic programme or release from prison in the control group.

Results

The odds of reincarceration, including arrests and new convictions, were similar for the two groups, but Transitions Clinic participants had lower odds of returning to prison for a parole or probation technical violation (adjusted OR: 0.38; 95% CI 0.16 to 0.93) compared with the control group. Further, Transitions Clinic participants had fewer incarceration days (incidence rate ratio: 0.55; 95% CI 0.35 to 0.84) compared with the control group.

Conclusions

Enhanced primary care for individuals just released from prison can reduce reincarceration for technical violations and shorten time spent within correctional facilities. This study shows how community health systems may play a role in current strategies to reduce prison populations.

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Most cited references 20

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The Mark of a Criminal Record

Devah Pager (2003)

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Zero-inflated Poisson and binomial regression with random effects: a case study.

D. Hall (2000)

In a 1992 Technometrics paper, Lambert (1992, 34, 1-14) described zero-inflated Poisson (ZIP) regression, a class of models for count data with excess zeros. In a ZIP model, a count response variable is assumed to be distributed as a mixture of a Poisson(lambda) distribution and a distribution with point mass of one at zero, with mixing probability p. Both p and lambda are allowed to depend on covariates through canonical link generalized linear models. In this paper, we adapt Lambert's methodology to an upper bounded count situation, thereby obtaining a zero-inflated binomial (ZIB) model. In addition, we add to the flexibility of these fixed effects models by incorporating random effects so that, e.g., the within-subject correlation and between-subject heterogeneity typical of repeated measures data can be accommodated. We motivate, develop, and illustrate the methods described here with an example from horticulture, where both upper bounded count (binomial-type) and unbounded count (Poisson-type) data with excess zeros were collected in a repeated measures designed experiment.

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Patient-centered community health worker intervention to improve posthospital outcomes: a randomized clinical trial.

Shreya Kangovi, Nandita Mitra, David Grande … (2014)

IMPORTANCE Socioeconomic and behavioral factors can negatively influence posthospital outcomes among patients of low socioeconomic status (SES). Traditional hospital personnel often lack the time, skills, and community linkages required to address these factors. OBJECTIVE To determine whether a tailored community health worker (CHW) intervention would improve posthospital outcomes among low-SES patients. DESIGN, SETTING, AND PARTICIPANTS A 2-armed, single-blind, randomized clinical trial was conducted between April 10, 2011, and October 30, 2012, at 2 urban, academically affiliated hospitals. Of 683 eligible general medical inpatients (ie, low-income, uninsured, or Medicaid) that we screened, 237 individuals (34.7%) declined to participate. The remaining 446 patients (65.3%) were enrolled and randomly assigned to study arms. Nearly equal percentages of control and intervention group patients completed the follow-up interview (86.6% vs 86.9%). INTERVENTIONS During hospital admission, CHWs worked with patients to create individualized action plans for achieving patients' stated goals for recovery. The CHWs provided support tailored to patient goals for a minimum of 2 weeks. MAIN OUTCOMES AND MEASURES The prespecified primary outcome was completion of primary care follow-up within 14 days of discharge. Prespecified secondary outcomes were quality of discharge communication, self-rated health, satisfaction, patient activation, medication adherence, and 30-day readmission rates. RESULTS Using intention-to-treat analysis, we found that intervention patients were more likely to obtain timely posthospital primary care (60.0% vs 47.9%; P = .02; adjusted odds ratio [OR], 1.52; 95% CI, 1.03-2.23), to report high-quality discharge communication (91.3% vs 78.7%; P = .002; adjusted OR, 2.94; 95% CI, 1.5-5.8), and to show greater improvements in mental health (6.7 vs 4.5; P = .02) and patient activation (3.4 vs 1.6; P = .05). There were no significant differences between groups in physical health, satisfaction with medical care, or medication adherence. Similar proportions of patients in both arms experienced at least one 30-day readmission; however, intervention patients were less likely to have multiple 30-day readmissions (2.3% vs 5.5%; P = .08; adjusted OR, 0.40; 95% CI, 0.14-1.06). Among the subgroup of 63 readmitted patients, recurrent readmission was reduced from 40.0% vs 15.2% (P = .03; adjusted OR, 0.27; 95% CI, 0.08-0.89). CONCLUSIONS AND RELEVANCE Patient-centered CHW intervention improves access to primary care and quality of discharge while controlling recurrent readmissions in a high-risk population. Health systems may leverage the CHW workforce to improve posthospital outcomes by addressing behavioral and socioeconomic drivers of disease. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT01346462.

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Author and article information

Journal

Journal ID (nlm-ta): BMJ Open

Journal ID (iso-abbrev): BMJ Open

Journal ID (hwp): bmjopen

Journal ID (publisher-id): bmjopen

Title: BMJ Open

Publisher: BMJ Publishing Group (BMA House, Tavistock Square, London, WC1H 9JR )

ISSN (Electronic): 2044-6055

Publication date Collection: 2019

Publication date (Electronic): 2 May 2019

Volume: 9

Issue: 5

Electronic Location Identifier: e028097

Affiliations

[1 ] departmentInternal Medicine , Yale University School of Medicine , New Haven, Connecticut, USA

[2 ] departmentSchool of Social Work , University of Connecticut System , Storrs, Connecticut, USA

[3 ] departmentResearch Division , Connecticut Department of Mental Health and Addiction Services , Hartford, Connecticut, USA

[4 ] Yale University School of Public Health , New Haven, Connecticut, USA

[5 ] Connecticut Department of Correction , Wethersfield, Connecticut, USA

[6 ] departmentFamily and Community Medicine , University of California, San Francisco , San Francisco, California, USA

Author notes

[Correspondence to ] Professor Emily A Wang; emily.wang@ 123456yale.edu

Article

Publisher ID: bmjopen-2018-028097

DOI: 10.1136/bmjopen-2018-028097

PMC ID: 6502013

PubMed ID: 31048315

SO-VID: 837a4ab6-9b3e-4bcb-a3f0-d3d6f4855788

License:

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

History

Date received : 21 November 2018

Date revision received : 15 January 2019

Date accepted : 04 March 2019

Funding

Funded by: FundRef http://dx.doi.org/10.13039/100005227, Centers for Medicare and Medicaid Services;

Funded by: FundRef http://dx.doi.org/10.13039/100005196, Bureau of Justice Assistance;

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ScienceOpen disciplines: Medicine

Keywords: primary care,prison,incarceration,social determinant of health

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ScienceOpen disciplines: Medicine

Keywords: primary care, prison, incarceration, social determinant of health

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Propensity-matched study of enhanced primary care on contact with the criminal justice system among individuals recently released from prison to New Haven

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Most cited references 20

The Mark of a Criminal Record

Zero-inflated Poisson and binomial regression with random effects: a case study.

Patient-centered community health worker intervention to improve posthospital outcomes: a randomized clinical trial.

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