Study Results
The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.
Basic Information
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COMPLETED
816 participants
OBSERVATIONAL
2013-05-31
2016-05-31
Brief Summary
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Detailed Description
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The project supports ongoing quality improvement at each of the 13 clinical sites by measuring the health, health care utilization, and the costs of caring for recently released patients. We will prospectively examine the rates of primary care engagement, acute care utilization, substance abuse and reported health, and recidivism in a cohort of 2000 patients recently released from prison receiving primary care at the 13 TCN programs. We will compare these rates of utilization at 6, 12, 18, 24, 30, 36 months to patient self-reported utilization prior to incarceration and historical controls.
Additionally, we aim to describe the implementation of, fidelity to, and sustainability of the TCN model in each of these clinical programs. Specifically, we aim to capture assets and barriers to starting and sustaining primary care programs targeting returning prisoners.
Conditions
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Keywords
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Study Design
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COHORT
PROSPECTIVE
Study Groups
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Former inmates
Former inmates with a chronic disease condition or aged 50 years and above engaged into primary care through an innovative primary care redesign model of the Transitions Clinic Network.
Primary care redesign
Connect individuals released from prison to primary care using trained, culturally competent primary care providers and community health workers (CHWs).
Interventions
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Primary care redesign
Connect individuals released from prison to primary care using trained, culturally competent primary care providers and community health workers (CHWs).
Eligibility Criteria
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Inclusion Criteria
* Has \>=1 chronic disease condition , and/or age \>=50 years
* Plans to live in the TCN area for the duration of the study
* Understands English or Spanish and able to provide consent
Exclusion Criteria
* Does not understand English or Spanish, or unable to provide consent
* Does not plan to receive healthcare through a TCN clinic
18 Years
ALL
No
Sponsors
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Yale University
OTHER
Responsible Party
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Principal Investigators
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Emily A Wang, MD, MAS
Role: PRINCIPAL_INVESTIGATOR
Yale University
Locations
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University of Alabama
Birmingham, Alabama, United States
Contra Costa Health Services (East and West Contra Costa)
Martinez, California, United States
Southeast Health Center
San Francisco, California, United States
Santa Clara Health Center
San Jose, California, United States
Yale Primary Care Center
New Haven, Connecticut, United States
East Baltimore Medical Center
Baltimore, Maryland, United States
Boston Healthcare for the Homeless Program
Boston, Massachusetts, United States
Morningside Clinic
New York, New York, United States
Montefiore Transition Clinic
New York, New York, United States
Medicine in Psychiatry Service clinic of the University of Rochester Medical Center
Rochester, New York, United States
Corporacion SANOS
Caguas, , Puerto Rico
Countries
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References
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Redmond N, Aminawung JA, Morse DS, Zaller N, Shavit S, Wang EA. Perceived Discrimination Based on Criminal Record in Healthcare Settings and Self-Reported Health Status among Formerly Incarcerated Individuals. J Urban Health. 2020 Feb;97(1):105-111. doi: 10.1007/s11524-019-00382-0.
Other Identifiers
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1301011280
Identifier Type: -
Identifier Source: org_study_id