Patients who were recently incarcerated are more likely to visit the emergency department (ED) and seek behavioral health treatment, according to a new study from a group of Advocate Aurora Research Institute scientists.
Recent incarceration also had a small effect on chronic disease incidence, the study found.
The investigators, led by Sarah Reimer, MD, a clinician investigator with the Research Institute and the Center for Urban Population Health, published their study findings in a recent issue of the Journal of Health Care for the Poor and Underserved. Andy Marek, manager of the Research Institute's Office of Research Analytics and System Computing, coauthored the journal article, along with former Research Institute team members Noah Pearce, Kayla Heslin, MPH, and Ana Perez Moreno, MD, PhD.
“Recent justice involvement impacts health care utilization, whether we are talking about emergency services, behavioral health or the clinic. The nature and size of the impact depends on gender and socioeconomic status, as this is a heterogenous population,” Dr. Reimer said. “Recently justice-involved individuals with lower socioeconomic status accessed behavioral health much less than those of higher status. Women of any socioeconomic status were more likely to use emergency services than were men, and, surprisingly, individuals with higher socioeconomic status, despite their having generally greater access to non-emergent health care, were more likely to visit the ED than were those of lower status.”
The purpose of the study was to use objective data to compare the health and health care utilization of recently incarcerated individuals, defined as having been released from jail or prison during the study period, with individuals who were not recently incarcerated.
“Our study differed from previous studies in that it relied on electronic health record documentation to determine a patient’s health status and health care utilization instead of relying on patient self-reporting, which may be less reliable,” Marek said. “We also used census information to control for neighborhood socioeconomic status, which heavily influences a person’s health profile.”
The research analyzed records from 2008 to 2017. They found that recently incarcerated individuals in the lowest socioeconomic group had five times the emergency services utilization as individuals in the same socioeconomic group who were not recently incarcerated. The recently incarcerated were also 2.7 times more likely to be considered health care “super-users,” defined as having two or more inpatient hospitalizations or four or more emergency department visits in any rolling 12-month period.
The study also found that recent incarceration had a minimal effect on the prevalence of diabetes, COPD and several cardiovascular diseases.
The authors suggest that future research should evaluate the impact of length or number of cycles of incarceration on health or health care utilization.
“This type of research is important as we work to address health equity in the communities we serve,” said Kurt Waldhuetter, the Research Institute’s vice president of research services. “Local health officials can use these findings to direct interventions that improve community health or increase engagement with local primary care or behavioral health services.”
The team’s research has already impacted operations at Advocate Aurora by revealing that the health system has provided care to more than 100,000 recently incarcerated individuals in Wisconsin. With Dr. Reimer’s research findings demonstrating the underlying need for a culturally competent care model for this population, Advocate Aurora implemented the Transitions Clinic model in conjunction with Progressive Community Health Center.
The model integrates community health workers with lived incarceration experience into the primary care team and connects those recently released into culturally competent care. It also helps recently incarcerated individuals meet social determinants of health needs by referring them to appropriate community benefits organizations.
The model has been shown to decrease ED utilization by 50%, reduce hospital lengths of stay by an average of one day and result in an average of 25 fewer days in jail in the first year after release.
“Both Advocate Aurora and Progressive Community Health Center are working closely with local Wisconsin Department of Corrections staff to provide smooth transitions of care for historical Advocate Aurora patients and for those most in need,” Dr. Reimer said.
To learn more about Advocate Aurora’s research, visit aurora.org/research.