A Patient Navigation Intervention for Drug-Involved Former Prison Inmates

ABSTRACT

Background: Former prison inmates experience high rates of hospitalizations and death during the transition from prison to the community, particularly from drug-related causes and early after release. The authors designed a randomized controlled trial (RCT) of patient navigation to reduce barriers to health care and hospitalizations for former prison inmates. Methods: Forty former prison inmates with a history of drug involvement were recruited and randomized within 15 days after prison release. Participants were randomized to receive 3 months of patient navigation (PN) with facilitated enrollment into an indigent care discount program (intervention) or facilitated enrollment into an indigent care discount program alone (control). Structured interviews were conducted at baseline, 3 months, and 6 months. Outcomes were measured as a change in self-reported barriers to care and as the rate of health service use per 100 person-days. Results: The mean number of reported barriers to care was reduced at 3 and 6 months in both groups. At 6 months, the rate of emergency department/urgent care visits per 100 person-days since baseline was 1.1 among intervention participants and 0.5 among control participants (P = .04), whereas the rate of hospitalizations per 100 person-days was 0.2 in intervention participants and 0.6 in control participants (P = .04). Conclusions: Recruitment of former inmates into an RCT of patient navigation was highly feasible, but follow-up was limited by rearrests. Results suggest a significantly lower rate of hospitalizations among navigation participants, although the rate of emergency department/urgent care visits was not improved. Patient navigation is a promising, pragmatic intervention that may be effective at reducing high-cost health care utilization in former prison inmates.

Keywords:

• Health care utilization
• patient navigation
• prisoners
• randomized controlled trials
• substance abuse
• vulnerable populations

ACKNOWLEDGMENTS

We wish to acknowledge Heather Salazar, Maureen O'Keefe, Sue Felton, Heather Wells, John Steiner, MD, MPH, Jean Kutner, MD, MSPH, Faye S. Taxman, PhD, and William Henderson, PhD, MPH.

FUNDING

This study was supported by the Robert Wood Johnson Physician Faculty Scholars Program and grant K12HS019464 from the Agency for Healthcare Research and Quality. This study was also supported by NIH/NCRR Colorado CTSI grant UL1 TR000154. The content is solely the responsibility of the authors and does not necessarily represent the official views of the Robert Wood Johnson Foundation, NIH, or the Agency for Healthcare Research and Quality.

AUTHOR CONTRIBUTIONS

I. A. Binswanger conceived and designed the study, obtained funding for the study, interpreted the data, and wrote and revised the manuscript. E. Whitley contributed to the design of the study and supervised the intervention. P. R. Haffey and S. R. Mueller collected the data. S.-J. Min analyzed the data.