Document text
Principal Investigator: Stacie Luther Daugherty
Organization: KAISER FOUNDATION RESEARCH INSTITUTE
Fiscal Year: 2024
Award: $774,872
Funding agency: National Heart Lung and Blood Institute
PROJECT SUMMARY/ABSTRACT
Societal systems of racism, segregation, and criminal justice practices have resulted in high rates of
imprisonment of Black, Indigenous, and other People of Color (BIPOC) and represent structural racism and
discrimination (SRD). Upon release from prison, people face further challenges influenced by SRD including
policies, procedures and practices in the healthcare system that limit access and contribute to poor health.
Compared to the general population, people released from prison have a higher prevalence of poor CV health,
an increased risk of CV events, and higher cardiovascular (CV) mortality within 2 years of release. Access to
healthcare following release from prison is key to preventing poor health outcomes in this population.
Systematic investigation of SRD in diverse healthcare systems 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 provide critical information
on SRD in healthcare organizations and begin to address the problem. In Aim 1, using three diverse 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, leveraging a database of individuals
released from Colorado state prisons (~400 a month), we will prospectively enroll 600 people recently released
from prison 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. Race/ethnicity and
baseline CV health will be examined as moderating variables because intersectional SRD may particularly
disadvantage BIPOC individuals released from prison and those with poor CV health. 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, their significant burden of poor health including CV disease and the disproportionate
imprisonment of BIPOC individuals, 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 and SRD requires understanding structural conditions at multiple levels.
Terms: <21+ years old><Access to Care><Active Follow-up><Address><Adult><Adult Human><Affect><Area><Attitude><Black><Black Populations><Black group><Black individual><Black people><Black race><Blacks><Cardiology><Cardiovascular><Cardiovascular Body System><Cardiovascular Diseases><Cardiovascular Organ System><Cardiovascular system><Clinic Visits><Cognitive Discrimination><Colorado><Communities><Criminal Justice><Data><Data Bases><Databases><Disadvantaged><Discrimination><Eligibility><Eligibility Determination><Emergencies><Emergency Situation><Employment><Enrollment><Ethnic Origin><Ethnicity><Event><Exposure to><Face><Focus Groups><Front line employee><Front line person><Front line personnel><Front line staff><Front line worker><Frontline employee><Frontline person><Frontline personnel><Frontline staff><Frontline worker><Future><General Population><General Public><Goals><Health><Health Care Systems><Health Care Utilization><Health Services Accessibility><Health system><Healthcare><Healthcare Systems><Heart Vascular><High Prevalence><History><Hospital Admission><Hospitalization><Housing><Imprisonment><Improve Access><Indigenous><Individual><Intervention><Intervention Strategies><Interview><Investigation><Link><Long-term cohort study><Longitudinal cohort study><Longterm cohort study><Measures><Medicaid><Observation in research><Organizational Policy><Outcome><Patients><Persons><Policies><Population><Prisons><Procedures><Protocol Screening><Race><Races><Recommendation><Recording of previous events><Research><Research Methodology><Research Methods><Services><Structural Racism><System><Testing><Visit><Writing><access disparities><access to health care><access to health services><access to healthcare><access to services><access to treatment><accessibility disparities><accessibility of health care><accessibility to health care><accessibility to health services><accessibility to healthcare><active followup><adulthood><availability of services><behavioral health><cardiovascular disorder><cardiovascular health><cardiovascular risk><cardiovascular risk factor><care access><care outcomes><circulatory system><cohort><community academic collaboration><community academic partnership><community academic research partnership><community advisory board><community advisory committee><community advisory panel><community based organizations><community organizations><community university partnership><data base><disparities in access><disparities in race><disparity due to race><disparity in health><enroll><faces><facial><follow up><follow-up><followed up><followup><group of color><health assessment><health care><health care access><health care availability><health care organization><health care outcomes><health care quality><health care service access><health care service availability><health care service organization><health care service use><health care service utilization><health disparity><health service access><health services availability><healthcare access><healthcare accessibility><healthcare availability><healthcare organization><healthcare outcomes><healthcare quality><healthcare service access><healthcare service availability><healthcare service organization><healthcare service use><healthcare service utilization><healthcare utilization><histories><housing instability><improved><incarcerated><incarceration><individual of color><inequality due to race><inequality in access><inequity due to race><inequity in access><inequity in accessibility><innovate><innovation><innovative><instably housed><interventional strategy><mortality><multidisciplinary><peer><people of color><person of color><poor health outcome><population of color><prevent><preventing><primary outcome><programs><prospective><race based disparity><race based inequality><race based inequity><race disparity><race related disparity><race related inequality><race related inequity><racial><racial background><racial disparity><racial inequality><racial inequity><racial origin><racially unequal><racism><reduced health outcome><research and methods><safety net><secondary outcome><segregation><service availability><social health determinants><social stigma><stigma><treatment access><unstable housing><unstably housed><worse health outcome>