Healthcare Organizational Structural Conditions and the Health of People Recently Released from Prison

医疗卫生组织结构状况与刑满释放人员健康状况

基本信息

批准号：
10699982
负责人：
Stacie Luther Daugherty
金额：
$ 79.14万
依托单位：
KAISER FOUNDATION RESEARCH INSTITUTE
依托单位国家：
美国
项目类别：
财政年份：
2022
资助国家：
美国
起止时间：
2022-09-07 至 2027-06-30
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10699982
关键词：
Address Adult Affect Area Attitude Black Populations Black race Cardiology Cardiovascular Diseases Cardiovascular system Clinic Visits Colorado Communities Criminal Justice Data Databases Disadvantaged Discrimination Eligibility Determination Emergency Situation Employment Enrollment Ethnic Origin Event Exposure to Face Focus Groups Frontline worker Future General Population Goals Health Health Services Accessibility Health system Healthcare Healthcare Systems High Prevalence Hospitalization Housing Imprisonment Improve Access Indigenous Individual Intervention Interview Investigation Link Longitudinal cohort study Measures Medicaid Observation in research Organizational Policy Outcome Patients Persons Policies Population Prisons Procedures Race Recommendation Recording of previous events Research Research Methodology Services Structural Racism System Testing Visit Writing access disparities behavioral health cardiovascular health cardiovascular risk factor care outcomes cohort community organizations follow-up health assessment health care availability health care quality health care service organization health care service utilization health disparity housing instability improved innovation mortality multidisciplinary peer people of color poor health outcome prevent primary outcome programs prospective racial disparity racism safety net secondary outcome segregation social health determinants social stigma

项目摘要

PROJECT SUMMARY/ABSTRACT Societal systems of racism, segregation, and criminal justice practices have resulted in high rates of imprisonment of Black, Indigenous, and other People of Color (BIPOC) and represent structural racism and discrimination (SRD). Upon release from prison, people face further challenges influenced by SRD including policies, procedures and practices in the healthcare system that limit access and contribute to poor health. Compared to the general population, people released from prison have a higher prevalence of poor CV health, an increased risk of CV events, and higher cardiovascular (CV) mortality within 2 years of release. Access to healthcare following release from prison is key to preventing poor health outcomes in this population. Systematic investigation of SRD in diverse healthcare systems has not occurred, and the extent to which different organizational policies and practices limit or perpetuate disparities in access and health outcomes among people released from prison is unknown. We propose three specific aims to provide critical information on SRD in healthcare organizations and begin to address the problem. In Aim 1, using three diverse health systems, we will analyze system written materials and conduct interviews and focus groups with system leaders, frontline staff, and representatives of community-based organizations to measure policies, practices and attitudes around healthcare access, transition programs, culture, support of social determinants of health and specialized services for people released from prison. In Aim 2, leveraging a database of individuals released from Colorado state prisons (~400 a month), we will prospectively enroll 600 people recently released from prison into a longitudinal cohort study to assess their exposure to healthcare structural conditions following release. Using the all-payer claims database, we will examine the association between exposure to structural conditions and 12-month primary outcomes of healthcare utilization (clinic visits, emergency visits, hospitalization) and secondary outcomes of CV hospitalization and all-cause mortality. Race/ethnicity and baseline CV health will be examined as moderating variables because intersectional SRD may particularly disadvantage BIPOC individuals released from prison and those with poor CV health. In Aim 3, we will integrate results from Aims 1 and 2 to develop practice recommendations to improve health care access and outcomes for people released from prison. Recommendations will be iteratively revised with a community advisory board and finalized using a modified Delphi panel of national experts. Final recommendations will be assembled and broadly disseminated. Given the enormity of the population of individuals with a history of imprisonment, their significant burden of poor health including CV disease and the disproportionate imprisonment of BIPOC individuals, a critical goal of our research is to identify targets for future interventions to improve access and health for people released from prison. Solutions to the significant problem of negative health consequences to imprisonment and SRD requires understanding structural conditions at multiple levels.

项目概要/摘要种族主义、种族隔离和刑事司法做法的社会制度导致了高比例的监禁黑人、原住民和其他有色人种 (BIPOC)，代表结构性种族主义和歧视（SRD）。出狱后，人们面临着受 SRD 影响的进一步挑战，包括医疗保健系统中限制获取并导致健康状况不佳的政策、程序和做法。与一般人群相比，出狱人员的心血管健康状况不佳的患病率更高，心血管事件风险增加，释放后 2 年内心血管 (CV) 死亡率更高。访问出狱后的医疗保健是防止该人群健康状况不佳的关键。尚未对不同医疗保健系统中的 SRD 进行系统调查，以及调查的程度不同的组织政策和做法限制或延续了获取和健康结果方面的差异出狱人员中的情况不得而知。我们提出三个具体目标来提供关键信息医疗机构中的 SRD 并开始解决该问题。在目标 1 中，使用三种不同的健康系统，我们将分析系统书面材料并利用系统进行访谈和焦点小组领导者、一线工作人员和社区组织代表衡量政策、实践以及围绕医疗保健获取、过渡计划、文化、对健康社会决定因素的支持的态度以及为刑满释放人员提供专门服务。在目标 2 中，利用个人数据库从科罗拉多州监狱释放的人（每月约 400 人），我们将前瞻性地招募最近释放的 600 人从监狱进入纵向队列研究，以评估他们对医疗结构状况的暴露程度发布后。使用所有付款人索赔数据库，我们将检查风险敞口之间的关联医疗保健利用的结构状况和 12 个月主要结果（门诊就诊、急诊就诊、住院）以及心血管住院和全因死亡率的次要结局。种族/民族和基线 CV 健康状况将作为调节变量进行检查，因为交叉 SRD 可能特别重要 BIPOC 出狱人员和简历健康状况不佳的人处于不利地位。在目标 3 中，我们将整合目标 1 和 2 的结果，制定实践建议，以改善医疗保健的可及性和出狱人员的结果。建议将与社区一起迭代修改顾问委员会并使用经过修改的德尔福国家专家小组最终确定。最终建议将是集结并广泛传播。鉴于有历史的个体人口数量巨大入狱、健康状况不佳（包括心血管疾病）和不成比例的严重负担对于 BIPOC 个人的监禁，我们研究的一个关键目标是确定未来干预措施的目标改善刑满释放人员的出入和健康状况。消极问题的解决方案监禁和SRD对健康的影响需要了解多个层面的结构条件。