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Patient safety systems use redundancy (double checking) procedures to minimize errors and prevent adverse and near-miss clinical events. However, redundancy and back-up procedures alone do not guarantee that patient morbidity and mortality will be reduced. In fact, patient safety literature now identifies the human factor as an essential element in outcomes. The human factor includes personal issues, task-oriented issues and interactions among staff. Most literature on patient safety calls for cultural changes in health care systems to minimize the human factor.

Approximately 6% to 10% of incarcerated women are pregnant on any given day, and it is estimated that as many as 1,400 women per year give birth while in custody. Pregnant women have unique health care and psychosocial needs. Pregnancies of incarcerated women are often high risk due to poor nutrition, limited access to prenatal care, domestic violence, mental illness, and drug and alcohol dependence. Optimizing maternal health, providing prenatal care, addressing pregnant women’s symptoms in a timely manner, and referral to a specialist when indicated are important for ensuring a healthy maternal–fetal unit and healthy birth outcomes. Physiologic changes of pregnancy and additional nutritional needs require correctional facilities to modify standard custodial routines, such as supplying additional food, housing women in a lower bunk, and having light-duty work assignments. 

This report is an excellent introduction to the relationship between incarceration and public health and its significance for society. It is essential reading for anyone working within the fields of corrections and public health. Sections cover: the burden of disease behind bars—mental health, substance use and addiction, infectious disease, chronic disease, violence and self-harm, greater health disparities for women, and geriatric health; conditions of confinement and health—overcrowding, solitary confinement, sexual victimization, and quality of care; the health of communities--family structure, education and employment opportunities, housing stability and social entitlements, health insurance, and political capital; a political landscape ripe for reform; and the potential of the Affordable Care Act (ACA)—bolstering community capacity, strengthening front-end alternatives to arrest, prosecution, and incarceration, bridging health and justice systems, enabling outreach and care coordination, enrolling across the criminal justice continuum, granting Medicaid waivers and innovation, advancing health information technology, and regional challenges with the ACA.

On Life Support: Public Health in the Age of Mass Incarceration Cover

“This report lays out ways that departments of corrections can consider to reduce inmate medical costs without affecting high standards for inmate medical services. Strategies for cost savings are presented that might be used by a department of corrections directly or included in contracts for outsourcing inmate health care. One or more prisons or jails across the nation use each strategy identified” (p. 4). This report is divided into two sections. Section 1—Summary: the issue of why so much money is spent on inmate health care; and the most promising cost-reduction approaches. Section 2—Detailed Analysis: reduce demand/need for medical care (i.e., improve the health of the inmate population, reduce unnecessary consumption of medical services, and divert/release sick individuals; reduce the cost for treating an inmate (i.e., reduce cost of pharmaceuticals, reduce cost of using outside medical care, use in-house medical services when less expensive, and tighten contracting and auditing); and synergistic approaches to health care cost reduction.

Opportunities for Cost Savings in Corrections Without Sacrificing Service Quality: Inmate Health Care Cover

“This report was designed as a resource for the justice and health fields to: Identify the full range of beneficial information exchanges between the criminal justice and healthcare systems; Provide detail on specific information exchanges within the context of routine criminal justice and health operations; Serve as a guide to policymakers and practitioners seeking to implement information exchange, by offering detail on workflow and implementation issues; and, Offer a “blueprint” to certain specific information exchanges through the development of technical use cases” (p. 13). Sections comprising this document are: executive summary—issue overview, key findings according to beneficial uses by the criminal justice system and by healthcare providers, types of information to be exchanged, and implementation of information exchange, and next steps; background; implementation issues and potential challenges—privacy and consent, technical considerations, cost, and organizational factors like trust and leadership; catalog of beneficial criminal justice and health information exchange—criminal justice and health connections Matrix, and 34 information exchange synopses; implementation scenarios for reentry into the community after incarceration, and community-based treatment with effective criminal justice supervision; and next step recommendations. Appendixes provide: a list of acronyms and abbreviations; contributors; Phase II recommendations; additional implementation challenges information (HIPAA, HITECH Act, and 42 CFR Part 2); related information, standards, and guidelines; and success stories for SMART and WITS, BHIPS/CMBHS, and the Hampton County Sheriff’s Department.

Opportunities for Information Sharing to Enhance Health and Public Safety Outcomes: A Report by the Criminal Justice and Health Collaboration Project, Version 1 Cover

In an effort to better understand the role of pharmaceuticals in the state correctional setting and budget, and in a state’s overall health care strategy, The Pew Charitable Trusts, in partnership with the Vera Institute of Justice, administered a survey in 2016 to each state’s department of corrections, receiving responses from every state except New Hampshire. Respondents were asked how much they spent on prescription drugs, what their highest-cost drugs were, whether they charged incarcerated adults copayments, and whether they had access to the federal Health Resources and Services Administration’s (HRSA) 340B discounted drug pricing program through an agreement with an eligible provider.

"Organizations in both the health care and criminal justice fields have been using predictive analytics for a while, but predictive analytics are just beginning to be used in what may best be described as the hybrid field of health care and criminal justice. Predictive analytics are deployed in this hybrid field to anticipate the health needs of the justice-involved, and use this information to treat mental illness as well as other health problems. The underlying assumption is that these pre-emptive actions will reduce the risk of reoffending and reincarceration and thereby promote public safety. In the field of criminal justice, predictive analytics have already been shown to increase public safety through crime prevention" (p. 1). This issue paper presents three case studies showing how predictive analytics is being used by hybrid health and criminal justice systems. The case studies are: the Otsuka Digital Health (ODH) platform in Miami-Dade County used to divert the mentally ill from the local justice system; the utilization of Impact Pro by Centurion (the correctional health care provider for the states of Tennessee, Minnesota, Massachusetts, and Vermont) to treat incarcerated individuals; and the web-based RNR Simulation Tool which generates evidence-based treatment recommendations for the offender.

Predictive Analytics in Health Care and Criminal Justice: Three Case Studies cover

Join the National Institute of Corrections (NIC), Federal Bureau of Prisons (FBOP) and the Centers for Disease Control (CDC) to learn about how current community hepatitis A outbreaks are affecting correctional jurisdictions, and how you can prevent cases from becoming outbreaks in your own facilities.

Information and resources that address the unique challenges of providing health services to youthful offenders are provided through this 20-hour training program. This manual is divided into the following sections: adolescent development; trends and health issues; organizational/administrative issues; security and classification; the role of the medical staff; professional boundaries; mental health disorders; substance abuse; suicide prevention/intervention; sexual/physical/emotional abuse; behavior management; female health issues; action planning; and supplemental readings.

Prison Health Care Cover

"People leaving prison often return to the community lacking health insurance and thus access to appropriate health care. Many have mental illness, substance abuse, and other health issues that need treatment and compound reintegration challenges. Left untreated, they are at risk of falling into a cycle of relapse, reoffending, and reincarceration. Providing Medicaid coverage upon release has the potential to improve continuity of care that may interrupt this cycle. This report examines whether efforts to enroll people in Medicaid prior to their release from prison are successful in generating health insurance coverage after release. Urban Institute (Urban) researchers analyzed data from Oregon’s pre-Affordable Care Act (ACA) Medicaid program to determine the extent to which released prisoners successfully gained coverage" (p. 1). The results from this study my help your state in ensuring continuity of care for newly released offenders.

Prison Inmates' Prerelease Application for Medicaid Cover


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