Online Program

Assessing chronic disease care in corrections

Sunday, November 3, 2013

Emily Wang, MD, MAS, Department of Medicine, Yale University School of Medicine, New Haven, CT
Jenerius Aminawung, M.D, MPH, Department of Internal Medicine, Yale School of Medicine, New Haven, CT
Carol Bova, PhD, RN, ANP, Graduate School of Nursing, University of Massachusetts, Worcester, MA
Background: Healthcare is constitutionally guaranteed in US prisons. However, there have been limited evaluations as to how well prison health systems are caring for patients with chronic conditions. We aimed to describe how clinical staff and administrators rate chronic disease care in prisons using a newly adapted instrument. Methods: We administered the Assessment of Chronic Illness Care-Prison (ACIC-P) to clinical staff and administrators of two northeastern prison systems. The ACIC-P was adapted from a validated instrument that assesses how well community healthcare organizations provide care, the Assessment of Chronic Illness Care instrument. It measures 6 components of chronic disease care in prisons: self-management support, linkages to community resources (including discharge planning), decision support, delivery system design, clinical information systems, and organization of the health system (including the role of corrections). Items within each component are scored between 0 and 11, where 0-2 = limited; 3-5= basic; 6-8 = reasonably good; and 9-11 = fully developed, chronic illness care. We describe measures of internal consistency, mean ACIC-P scores, and compared scores by those providing direct patient care, and length of practice in prison health using nonparametric tests. Results: Fifty-seven ACIC-P surveys have been completed, for a response rate of 62%. The mean age of respondents was 48.7 ± 9.8 years; 31 (54%) were women; 41 (72%) identified as White; and 42 (74%) clinical staff. Overall, respondents perceived prison systems,offer basic support for chronic illness care (ACIC-P score= 5.5 ±1.5). Internal consistency as represented by Cronbach's alpha ranged from “questionable” for the clinical linkages subscale to “good” for the organization of the health system. Both systems are viewed as providing “reasonably good” support for chronic illness care in terms of clinical linkages (6.7 ±1.7) and organization of the health system (6.3 ± 1.8), but only ‘basic support' with respect to self-management support (4.5 ± 2.1), clinical information systems (5.0 ± 2.1), decision support (5.5±1.9), and delivery system design (5.9±1.8). Administrators reported higher scores (reasonably good support) for organization of the health system, decision support, delivery system design and clinical information systems compared to clinical providers (basic support). There was a strong positive correlation between length of practice in prison health and ACIC-P score (ρ=0.42, p<0.01). Conclusion: Prison health staff and administration in the two states are providing basic chronic illness care and can improve in realms of patient self-management support, clinical information systems, decision support, and delivery system design.

Learning Areas:

Chronic disease management and prevention

Learning Objectives:
List challenges to providing chronic disease care in correctional settings. Identify challenges for using standardized community tools within correctional healthcare settings. Discuss the Assessment of Chronic Illness Care-Prison instrument in evaluating chronic disease care in corrections.

Keyword(s): Chronic Diseases, Correctional Health Care

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am primary care physician and researcher who is focused on understanding how best to improve the health of individuals with a history of incarceration. I am the principal investigator of a number of federally funded grants studying the health impacts of incarceration and the efficacy of interventions in prison and community health care settings to improve these patients' health.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.