Increased hospital and emergency department utilization by individuals with recent criminal justice involvement: Results of a national survey

Joseph W. Frank, Jeffrey A. Linder, William C. Becker, David A. Fiellin, Emily A. Wang

Research output: Contribution to journalArticle

26 Citations (Scopus)

Abstract

BACKGROUND: Individuals involved with the criminal justice system have increased health needs and poor access to primary care. OBJECTIVE: To examine hospital and emergency department (ED) utilization and related costs by individuals with recent criminal justice involvement. DESIGN: Cross-sectional survey. PARTICIPANTS: Non-institutionalized, civilian U.S. adult participants (n=154,356) of the National Survey on Drug Use and Health (2008-2011). MAIN MEASURES: Estimated proportion of adults who reported past year 1) hospitalization or 2) ED utilization according to past year criminal justice involvement, defined as 1) parole or probation, 2) arrest without subsequent correctional supervision, or 3) no criminal justice involvement; estimated annual expenditures using unlinked data from the Medical Expenditure Panel Survey. KEY RESULTS: An estimated 5.7 million adults reported parole or probation and an additional 3.9 million adults reported an arrest in the past year. Adults with recent parole or probation and those with a recent arrest, compared with the general population, had higher rates of hospitalization (12.3 %, 14.3 %, 10.5 %; P<0.001) and higher rates of ED utilization (39.3 %, 47.2 %, 26.9 %; P<0.001). Recent parole or probation was an independent predictor of hospitalization (adjusted odds ratio [AOR], 1.21; 95 % confidence interval [CI], 1.02-1.44) and ED utilization (AOR, 1.35; 95 % CI, 1.12-1.63); Recent arrest was an independent predictor of hospitalization (AOR, 1.26; 95 % CI, 1.08-1.47) and ED utilization (AOR, 1.81; 95 % CI, 1.53-2.15). Individuals with recent criminal justice involvement make up 4.2 % of the U.S. adult population, yet account for an estimated 7.2 % of hospital expenditures and 8.5 % of ED expenditures. CONCLUSIONS: Recent criminal justice involvement is associated with increased hospital and ED utilization and costs. The criminal justice system may offer an important point of contact for efforts to improve the healthcare utilization patterns of a large and vulnerable population.

Original languageEnglish (US)
Pages (from-to)1226-1233
Number of pages8
JournalJournal of general internal medicine
Volume29
Issue number9
DOIs
StatePublished - Jan 1 2014

Fingerprint

Criminal Law
Hospital Departments
Hospital Emergency Service
Health Expenditures
Hospitalization
Odds Ratio
Confidence Intervals
Costs and Cost Analysis
Health
Vulnerable Populations
Surveys and Questionnaires
Population
Primary Health Care
Cross-Sectional Studies
Delivery of Health Care
Pharmaceutical Preparations

Keywords

  • emergency medicine
  • health care costs
  • hospital medicine
  • vulnerable populations

ASJC Scopus subject areas

  • Internal Medicine

Cite this

@article{2caa7c50c0c245b8b312ced1ae4c26d9,
title = "Increased hospital and emergency department utilization by individuals with recent criminal justice involvement: Results of a national survey",
abstract = "BACKGROUND: Individuals involved with the criminal justice system have increased health needs and poor access to primary care. OBJECTIVE: To examine hospital and emergency department (ED) utilization and related costs by individuals with recent criminal justice involvement. DESIGN: Cross-sectional survey. PARTICIPANTS: Non-institutionalized, civilian U.S. adult participants (n=154,356) of the National Survey on Drug Use and Health (2008-2011). MAIN MEASURES: Estimated proportion of adults who reported past year 1) hospitalization or 2) ED utilization according to past year criminal justice involvement, defined as 1) parole or probation, 2) arrest without subsequent correctional supervision, or 3) no criminal justice involvement; estimated annual expenditures using unlinked data from the Medical Expenditure Panel Survey. KEY RESULTS: An estimated 5.7 million adults reported parole or probation and an additional 3.9 million adults reported an arrest in the past year. Adults with recent parole or probation and those with a recent arrest, compared with the general population, had higher rates of hospitalization (12.3 {\%}, 14.3 {\%}, 10.5 {\%}; P<0.001) and higher rates of ED utilization (39.3 {\%}, 47.2 {\%}, 26.9 {\%}; P<0.001). Recent parole or probation was an independent predictor of hospitalization (adjusted odds ratio [AOR], 1.21; 95 {\%} confidence interval [CI], 1.02-1.44) and ED utilization (AOR, 1.35; 95 {\%} CI, 1.12-1.63); Recent arrest was an independent predictor of hospitalization (AOR, 1.26; 95 {\%} CI, 1.08-1.47) and ED utilization (AOR, 1.81; 95 {\%} CI, 1.53-2.15). Individuals with recent criminal justice involvement make up 4.2 {\%} of the U.S. adult population, yet account for an estimated 7.2 {\%} of hospital expenditures and 8.5 {\%} of ED expenditures. CONCLUSIONS: Recent criminal justice involvement is associated with increased hospital and ED utilization and costs. The criminal justice system may offer an important point of contact for efforts to improve the healthcare utilization patterns of a large and vulnerable population.",
keywords = "emergency medicine, health care costs, hospital medicine, vulnerable populations",
author = "Frank, {Joseph W.} and Linder, {Jeffrey A.} and Becker, {William C.} and Fiellin, {David A.} and Wang, {Emily A.}",
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Increased hospital and emergency department utilization by individuals with recent criminal justice involvement : Results of a national survey. / Frank, Joseph W.; Linder, Jeffrey A.; Becker, William C.; Fiellin, David A.; Wang, Emily A.

In: Journal of general internal medicine, Vol. 29, No. 9, 01.01.2014, p. 1226-1233.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Increased hospital and emergency department utilization by individuals with recent criminal justice involvement

T2 - Results of a national survey

AU - Frank, Joseph W.

AU - Linder, Jeffrey A.

AU - Becker, William C.

AU - Fiellin, David A.

AU - Wang, Emily A.

PY - 2014/1/1

Y1 - 2014/1/1

N2 - BACKGROUND: Individuals involved with the criminal justice system have increased health needs and poor access to primary care. OBJECTIVE: To examine hospital and emergency department (ED) utilization and related costs by individuals with recent criminal justice involvement. DESIGN: Cross-sectional survey. PARTICIPANTS: Non-institutionalized, civilian U.S. adult participants (n=154,356) of the National Survey on Drug Use and Health (2008-2011). MAIN MEASURES: Estimated proportion of adults who reported past year 1) hospitalization or 2) ED utilization according to past year criminal justice involvement, defined as 1) parole or probation, 2) arrest without subsequent correctional supervision, or 3) no criminal justice involvement; estimated annual expenditures using unlinked data from the Medical Expenditure Panel Survey. KEY RESULTS: An estimated 5.7 million adults reported parole or probation and an additional 3.9 million adults reported an arrest in the past year. Adults with recent parole or probation and those with a recent arrest, compared with the general population, had higher rates of hospitalization (12.3 %, 14.3 %, 10.5 %; P<0.001) and higher rates of ED utilization (39.3 %, 47.2 %, 26.9 %; P<0.001). Recent parole or probation was an independent predictor of hospitalization (adjusted odds ratio [AOR], 1.21; 95 % confidence interval [CI], 1.02-1.44) and ED utilization (AOR, 1.35; 95 % CI, 1.12-1.63); Recent arrest was an independent predictor of hospitalization (AOR, 1.26; 95 % CI, 1.08-1.47) and ED utilization (AOR, 1.81; 95 % CI, 1.53-2.15). Individuals with recent criminal justice involvement make up 4.2 % of the U.S. adult population, yet account for an estimated 7.2 % of hospital expenditures and 8.5 % of ED expenditures. CONCLUSIONS: Recent criminal justice involvement is associated with increased hospital and ED utilization and costs. The criminal justice system may offer an important point of contact for efforts to improve the healthcare utilization patterns of a large and vulnerable population.

AB - BACKGROUND: Individuals involved with the criminal justice system have increased health needs and poor access to primary care. OBJECTIVE: To examine hospital and emergency department (ED) utilization and related costs by individuals with recent criminal justice involvement. DESIGN: Cross-sectional survey. PARTICIPANTS: Non-institutionalized, civilian U.S. adult participants (n=154,356) of the National Survey on Drug Use and Health (2008-2011). MAIN MEASURES: Estimated proportion of adults who reported past year 1) hospitalization or 2) ED utilization according to past year criminal justice involvement, defined as 1) parole or probation, 2) arrest without subsequent correctional supervision, or 3) no criminal justice involvement; estimated annual expenditures using unlinked data from the Medical Expenditure Panel Survey. KEY RESULTS: An estimated 5.7 million adults reported parole or probation and an additional 3.9 million adults reported an arrest in the past year. Adults with recent parole or probation and those with a recent arrest, compared with the general population, had higher rates of hospitalization (12.3 %, 14.3 %, 10.5 %; P<0.001) and higher rates of ED utilization (39.3 %, 47.2 %, 26.9 %; P<0.001). Recent parole or probation was an independent predictor of hospitalization (adjusted odds ratio [AOR], 1.21; 95 % confidence interval [CI], 1.02-1.44) and ED utilization (AOR, 1.35; 95 % CI, 1.12-1.63); Recent arrest was an independent predictor of hospitalization (AOR, 1.26; 95 % CI, 1.08-1.47) and ED utilization (AOR, 1.81; 95 % CI, 1.53-2.15). Individuals with recent criminal justice involvement make up 4.2 % of the U.S. adult population, yet account for an estimated 7.2 % of hospital expenditures and 8.5 % of ED expenditures. CONCLUSIONS: Recent criminal justice involvement is associated with increased hospital and ED utilization and costs. The criminal justice system may offer an important point of contact for efforts to improve the healthcare utilization patterns of a large and vulnerable population.

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KW - health care costs

KW - hospital medicine

KW - vulnerable populations

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