Emergency department utilization among recently released prisoners: a retrospective cohort study

Joseph W. Frank · Christina M. Andrews · Traci Craig Green · Aaron M. Samuels · Peter D. Friedmann

99 citations0/0 files storedBMC Emergency Medicine

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Criminal Justice and Corrections Analysis Substance Abuse Treatment and Outcomes Emergency and Acute Care Studies

Abstract

BACKGROUND: The population of ex-prisoners returning to their communities is large. Morbidity and mortality is increased during the period following release. Understanding utilization of emergency services by this population may inform interventions to reduce adverse outcomes. We examined Emergency Department utilization among a cohort of recently released prisoners. METHODS: We linked Rhode Island Department of Corrections records with electronic health record data from a large hospital system from 2007 to 2009 to analyze emergency department utilization for mental health disorders, substance use disorders and ambulatory care sensitive conditions by ex-prisoners in the year after release from prison in comparison to the general population, controlling for patient- and community-level factors. RESULTS: There were 333,369 total ED visits with 5,145 visits by a cohort of 1,434 ex-prisoners. In this group, 455 ex-prisoners had 3 or more visits within 1 year of release and 354 had a first ED visit within 1 month of release. ED visits by ex-prisoners were more likely to be made by men (85% vs. 48%, p < 0.001) and by blacks (26% vs. 16%, p < 0.001) compared to the Rhode Island general population. Ex-prisoners were more likely to have an ED visit for a mental health disorder (6% vs. 4%, p < 0.001) or substance use disorder (16%vs. 4%, p < 0.001). After controlling for patient- and community-level factors, ex-prisoner visits were significantly more likely to be for mental health disorders (OR 1.43; 95% CI 1.27-1.61), substance use disorders (OR 1.93; 95% CI 1.77-2.11) and ambulatory care sensitive conditions (OR 1.09; 95% CI 1.00-1.18). CONCLUSIONS: ED visits by ex-prisoners were significantly more likely due to three conditions optimally managed in outpatient settings. Future work should determine whether greater access to outpatient services after release from prison reduces ex-prisoners' utilization of emergency services.

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References

2007Release from Prison — A High Risk of Death for Former Inmates 2006Mental Health Problems of Prison and Jail Inmates 2001Ethnic Disparities in Unmet Need for Alcoholism, Drug Abuse, and Mental Health Care 2009The Health and Health Care of US Prisoners: Results of a Nationwide Survey 2009Prevalence of chronic medical conditions among jail and prison inmates in the USA compared with the general population 2010Meta‐analysis of drug‐related deaths soon after release from prison 2002The Burden of Infectious Disease Among Inmates of and Releasees From US Correctional Facilities, 1997 2006Drug Use and Dependence, State and Federal Prisoners, 2004

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2014Increased Hospital and Emergency Department Utilization by Individuals with Recent Criminal Justice Involvement: Results of a National Survey

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