Healthcare Organizational Structural Conditions and the Health of People Recently Released from Prison - Upon release from prison, people face numerous challenges including unstable housing, limited employment, and poor health. Healthcare system structural conditions, or their policies, procedures and practices, may limit access and contribute to poor health. Compared to the general population, people released from prison have a higher prevalence of poor cardiovascular (CV) health, an increased risk of CV events, and higher CV mortality after release. Access to healthcare following release from prison is key to preventing poor health outcomes in this population. Systematic investigation of healthcare system policies and practices 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 begin to address the problem. In Aim 1, using three different 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, we will prospectively enroll up to 600 people recently released from Colorado prisons 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. Baseline CV health will be examined as moderating variables. 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 and their significant burden of poor health including CV disease, 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 require understanding structural conditions at multiple levels.
