Structural Conditions and Health After Release From Prison

Study Overview
=================
Brief Summary
-----------------
People released from prison experience two times higher cardiovascular (CV) mortality than the general population, have a high prevalence of poor CV health and increased risk of CV events within 2 years of release. Access to high quality healthcare following release from prison is key to preventing poor health and CV outcomes. Our study team will investigate facilitators and barriers to health care access experienced by people released from prison.

Detailed Description
-----------------
Upon release from prison, people face numerous challenges including unstable housing, limited employment, stigma, and poor health. Structural conditions in healthcare systems, including policies, practices and attitudes around healthcare access, transition programs, culture, support of social determinants of health, and specialized services for people released from prison, may influence access and health outcomes for people released from prison. We will enroll people released from prison into a prospective cohort study to 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. Moderation by participant characteristics such as self-reported race, ethnicity, gender, age and baseline CV health will be tested.

Official Title
-----------------
Healthcare Organizational Structural Conditions and the Health of People Recently Released From Prison

Conditions
-----------------
Cardiovascular Diseases, Health Care Utilization

Participation Criteria
=================
Eligibility Criteria
-----------------
Inclusion Criteria: Recenlty released from state prison into the Denver/Aurora Colorado metro area Age 18 and older Ability to understand study procedures in English or Spanish No plans to leave the area for six months Exclusion Criteria: On current inmate status or still under correctional observation (i.e., under locked confinement part of the day or night) Plans to leave area within six months Unable to consent

Ages Eligible for Study
-----------------
Minimum Age: 18 Years

Sexes Eligible for Study
-----------------
All

Accepts Healthy Volunteers
-----------------
Accepts Healthy Volunteers

Study Plan
=================
How is the study designed?
-----------------

Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Exposure to structural conditions<br>Using a survey, we will measure participant exposure to organizational: access policies, transition programs, culture, support for social determinants of health and specialized services. | |

What is the study measuring?
-----------------
Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Healthcare utilization | Clinic visits, emergency visits, hospitalization | 12 months | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Cardiovascular hospitalization | Hospitalization for a cardiovascular condition | 12 months | 
| Death | All-cause death | 12 months |