Assessing jails' use of community-based emergency care in the US South

评估美国南部监狱对社区紧急护理的使用情况

• 批准号: 9471125
• 负责人: DAVID L ROSEN
• 金额: $ 68.74万
• 依托单位: UNIV OF NORTH CAROLINA CHAPEL HILL
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-09-26 至 2021-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9471125
• 关键词: Accident and Emergency department; Acute; Address; Administrator; Alabama; Alcohol or Other Drugs use; Alcohols; Ambulances; Ambulatory Care; Attention; Caring; Cause of Death; Cessation of life; Characteristics; Chemicals; Chronic; Cities; Clinical; Color; Communicable Diseases; Communities; Community Health; Complement; Computerized Medical Record; Cost Savings; County; Data; Databases; Dependency; Diabetes Mellitus; Drug Addiction; Emergency Care; Emergency Situation; Emergency medical service; Emotional Stress; Event; Expenditure; Family health status; Frequencies; Geographic state; Health; Health Care Costs; Health Personnel; Health Policy; Health Services; Health Surveys; Healthcare; Healthcare Systems; Hospitalization; Hospitals; Imprisonment; Individual; Injury; Intervention; Jail; Link; Low income; Medical Records; Medical emergency; Mental Health; Myocardial Infarction; North Carolina; Patient Self-Report; Persons; Pharmaceutical Preparations; Pharmacotherapy; Policies; Policy Maker; Population; Population Sizes; Poverty; Prevalence; Prisoner; Procedures; Public Health; Records; Recruitment Activity; Reporting; Research; Resources; Running; Rural; Services; Shapes; Shoulder; Signal Transduction; South Carolina; Suicide; Surveys; Symptoms; System; Time; Trauma; Violence; West Virginia; Withdrawal; base; burden of illness; cost; disability; experience; health care delivery; improved; insight; novel; prevent; prospective; response; screening; tool

The US has the highest incarceration rate in the world. Each year in the US, jails incarcerate 12 million people, most of whom are either awaiting sentencing or serving out short sentences. Persons of color are incarcerated at disproportionately high rates, and as a class, incarcerated persons have worse health than other US residents. Jail inmates shoulder a heavy burden of mental health conditions (64%), chemical dependency (68%), infectious diseases (14%) and other chronic conditions (45%). Custody in jail can be a time of heightened physical and emotional stress, and indeed myocardial infarction and suicide are the two most frequent causes of death during incarceration. The heavy burden of health problems and large size of this population in combination with generally short incarcerations and limited healthcare resources present formidable challenges addressing jail inmates’ healthcare needs. These challenges may be particularly difficult for southern jails, which are often small-sized and located in rural, resource-limited communities whose populations have relatively high rates of poverty and disability compared to other US regions. In recent years, deaths occurring during incarceration have created heightened attention regarding jail health services, and in 2011 there was a broad national survey of jail inmates’ self-reported health conditions. However, the broad inmate survey did not reflect acute care needs and was susceptible to self-report bias, while reported deaths are rare events that provide only limited insight into inmates’ health and healthcare. Because of a variety of barriers, few studies have examined the delivery of healthcare for jail inmates. Robust indicators of inmates’ immediate healthcare needs—and the extent to which their needs exceed jail healthcare resources—could be used to target interventions to improve jail healthcare and reduce costs. A novel and potentially powerful indicator signaling that inmates’ healthcare needs exceed jail healthcare resources is the extent to which jails use community Emergency Management Service (EMS) ambulances and emergency departments (EDs) to provide care. Enumerating the prevalence of health conditions, particularly traumas and ambulatory-care sensitive conditions, resulting in EMS/ED care may in turn identify opportunities to modify jail policies—both custodial and health—to diminish violence, improve health, and reduce healthcare costs. Accordingly, using a combination of prospective survey findings and analyses of statewide emergency care databases in 5 southern US states, we will examine the healthcare resources available in county jails, describe the frequency and types of conditions for which jails rely upon EMS and ED care to supplement their health services, and estimate the cost savings that jails could accrue by preventing the need for EMS, ED, and hospitalization care for ambulatory-sensitive conditions and traumas. These findings will represent a key tool in strengthening jail healthcare, improving inmate health, reducing costs, and ultimately, protecting the health of the families and communities to which inmates return

美国的监禁率最高。每年在美国，监狱监禁1200万 人们，大多数人要么在等待句子，要么句简短句子。有色人种是 以不成比例的比例监禁，作为班级，继承的人的健康状况要比 其他美国居民。监狱囚犯肩负着严重的心理健康状况（64％），化学状况 依赖性（68％），传染病（14％）和其他慢性病（45％）。监狱中的监护权可能是 身体和情感压力增加的时间，实际上是心肌梗死和自杀的时间 监禁期间最常见的死亡原因。健康问题的大量燃烧和大范围 人口结合通常短期监禁和有限的医疗资源 强大的挑战解决了监狱囚犯的医疗保健需求。这些挑战可能特别困难 对于南部监狱，通常是小型的，位于农村的，有限资源的社区 与其他美国地区相比，人口的贫困和残疾率相对较高。 近年来，监禁期间发生的死亡引起了人们对监狱的关注 卫生服务，2011年，对监狱囚犯自我报告的健康状况进行了广泛的调查。 但是，广泛的囚犯调查并没有反映急性护理需求，并且容易受到自我报告偏见的影响， 据报道，死亡是罕见的事件，仅提供对感染的健康和医疗保健的有限见解。 由于各种障碍，很少有研究检查监狱囚犯的医疗保健。 囚犯直接医疗保健需求的强大指标以及其需求超过监狱的程度 医疗保健资源 - 可以用于针对干预措施，以改善监狱医疗保健并降低成本。一个 新颖且潜在的强大指标表明，囚犯的医疗保健需求超过监狱医疗保健 资源是监狱使用社区紧急管理服务（EMS）救护车的程度和 急诊科（ED）提供护理。列举健康状况的患病率，特别是 创伤和室内护理敏感条件，导致EMS/ED护理可能会确定机会 修改监狱政策（包括保管和健康），以减少暴力，改善健康并减少医疗保健 费用。彼此之间，结合了前瞻性调查结果和全州紧急情况的分析 美国南部5个州的护理数据库，我们将检查县监狱可用的医疗资源， 描述监狱依赖EMS和ED关心的条件的频率和类型 卫生服务，并估算监狱可以节省的成本，可以防止EMS，ED和 住院治疗对卧床敏感条件和创伤的护理。这些发现将代表一个关键工具 加强监狱医疗保健，改善囚犯的健康，降低成本，并最终保护 囚犯返回的家庭和社区