Original Investigation |

A High Risk of Hospitalization Following Release From Correctional Facilities in Medicare Beneficiaries:  A Retrospective Matched Cohort Study, 2002 to 2010

Emily A. Wang, MD, MAS1; Yongfei Wang, MS2,3; Harlan M. Krumholz, MD, SM2,3,4,5
[+] Author Affiliations
1Section of General Internal Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut
2Yale–New Haven Hospital Center of Outcomes Research and Evaluation, New Haven, Connecticut
3Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut
4Robert Wood Johnson Clinical Scholars Program, New Haven, Connecticut
5Section of Health Policy and Administration, Yale University School of Public Health, New Haven, Connecticut
JAMA Intern Med. 2013;173(17):1621-1628. doi:10.1001/jamainternmed.2013.9008.
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Importance  Little is known about the risk of individuals who are released from correctional facilities, a time when there may be discontinuity in care.

Objective  To study the risk for hospitalizations among former inmates soon after their release from correctional facilities.

Design  Retrospective cohort study.

Participants  Data from Medicare administrative claims for 110 419 fee-for-service beneficiaries who were released from a correctional facility from 2002 through 2010 and controls matched by age, sex, race, Medicare status, and residential zip code.

Main Outcomes and Measures  Hospitalization rates and specifically those for ambulatory care–sensitive conditions 7, 30, and 90 days after release.

Results  Of 110 419 released inmates, 1559 individuals (1.4%) were hospitalized within 7 days after release; 4285 individuals (3.9%) within 30 days; and 9196 (8.3%) within 90 days. The odds of hospitalization was higher for released inmates compared with those of matched controls (within 7 days: odds ratio [OR], 2.5 [95% CI, 2.3-2.8]; within 30 days: OR, 2.1 [95% CI, 2.0-2.2]; and within 90 days: OR, 1.8 [95% CI, 1.7-1.9]). Compared with matched controls, former inmates were more likely to be hospitalized for ambulatory care–sensitive conditions (within 7 days: OR, 1.7 [95% CI, 1.4-2.1]; within 30 days: OR, 1.6 [95% CI, 1.5-1.8]; and within 90 days: OR, 1.6 [95% CI, 1.5-1.7]).

Conclusions and Relevance  About 1 in 70 former inmates are hospitalized for an acute condition within 7 days of release, and 1 in 12 by 90 days, a rate much higher than in the general population.

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Time to First Hospitalization and Death

Time to first hospitalization (A) and death (B) stratified by incarceration status in the matched cohort of Medicare beneficiaries.

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