Evaluation of Transitions Clinic: A Post-Release Clinic for Recently Released Parolees With Chronic Medical Conditions

Study Overview
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Brief Summary
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The purpose of this study is to study the effectiveness of the Transitions Clinic, a post-release clinic for parolees with chronic medical conditions, in achieving increased primary care engagement, lower rates of inappropriate hospitalizations, psychiatric emergency service and emergency department use, and decreased recidivism. We hypothesize that subjects receiving parolee-targeted care in the Transitions Clinic will have increased rates of non-emergency department ambulatory care and outpatient mental health care, lower rates of hospitalization, psychiatric emergency service (PES) utilization, emergency department (ED) utilization, decreased total hospital length of stay, and decreased recidivism compared to patients receiving primary care from other safety-net providers.

Detailed Description
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With ever increasing numbers of released inmates, policymakers are developing policy initiatives and directing funding towards community reentry programs for recent parolees to decrease recidivism and improve health outcomes. These reentry programs are comprehensive efforts that coordinate social and medical services for recently incarcerated people to achieve these aims. Due to documented poor health outcomes in this population and the resultant costs on the public health system, provision of medical care will be an integral part of these reentry initiatives. The manner in which medical care is incorporated into community reentry programs and directed to recently released prisoners needs to be studied to guide architects of reentry programs, policymakers and allocation of funding. The Transitions Clinic (TC) was founded to address the medical needs of recently released prisoners. The TC is a pilot project designed to target primary care medical services to parolees in San Francisco and aid in coordination of medical and social services. It operates within the San Francisco Department of Public Health(SFDPH)-affiliated Community Health Network (CHN) and is part of the Safe Communities Reentry Council, a city-wide, collaborative effort of the Sheriff's office, Public Defenders' office and local community organizations to improve reentry services and outcomes for the 1500 annual parolees to San Francisco. The proposed project will prospectively examine the effectiveness of the TC in achieving increased primary care engagement, decreased acute health care utilization and decreased recidivism. After intake in the TC, patients will be randomized to continued, parolee-targeted care in TC versus referral to safety net medical providers for non-targeted care. We believe that the results of the study will assist policymakers by improving our understanding of the: effect of targeted and non-targeted medical care provision to post-release prisoners on primary care engagement and utilization effect of targeted and non-targeted medical care provision to post-release prisoners on inpatient hospitalizations and emergency room and psychiatric emergency service utilization. effect of targeted and non-targeted care provision to post-release prisoners on recidivism costs for provision of targeted versus non-targeted medical care to post-release prisoners (Do we want to do a cost analysis?)

Official Title
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The Impact of Parolee-Targeted Care Versus Expedited Usual Care on Health Care Utilization and Recidivism

Conditions
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Health Services Research, Prisons, Delivery of Health Care, Vulnerable Populations, Community Health Aides

Intervention / Treatment
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* Other: Transitions Clinic - parolee-targeted care
* Other: Expedited Primary Care


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: All adult parolees to San Francisco Must have one chronic condition or age >50 years old Exclusion Criteria: Children Subjects who already have an established primary care provider in San Francisco

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Health Services Research
Allocation: Randomized
Intervention Model: Parallel Assignment


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: Expedited Primary Care<br>Following randomization, subjects receive ongoing primary care in the San Francisco Department of Public Health affiliated primary care network. Appointments are expedited with safety-net primary care providers. | Other: Expedited Primary Care<br>* Following randomization, subjects receive ongoing primary care in the San Francisco Department of Public Health affiliated primary care network. Appointments are expedited with safety-net primary care providers.<br>|
| Experimental: Transitions Clinic - Parolee Targeted Care<br>Following randomization, subjects in this arm receive ongoing primary care in a parolee-targeted clinic. Parolee-targeted care includes care from clinicians with a knowledge of the impacts of incarceration on health and experience caring for formerly incarcerated patients, a community health worker that works in medical and social services coordination and chronic disease education, and linkages with community-based organizations serving formerly incarcerated individuals. | Other: Transitions Clinic - parolee-targeted care<br>* Subjects receive ongoing primary care from the Transitions Clinic versus ongoing primary care in the San Francisco Department of Public Health affiliated primary care network.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Acute Care Utilization | Hospitalization and hospital length of stay and psychiatric emergency and emergency department utilization | 6 months | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Primary Care Engagement | Non-emergency department visits to ambulatory primary care and mental health providers | 6 months | 
| Recidivism | Rate of re-incarceration during study period | 6 months | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Post-release, community health