title: Frequent emergency department use among released prisoners with human immunodeficiency virus: characterization including a novel multimorbidity index.
abstract: OBJECTIVE
  The objective was to characterize the medical, social, and psychiatric correlates of frequent emergency department (ED) use among released prisoners with human immunodeficiency virus (HIV).
  
  
  METHODS
  Data on all ED visits by 151 released prisoners with HIV on antiretroviral therapy (ART) were prospectively collected for 12 months. Correlates of frequent ED use, defined as having two or more ED visits postrelease, were described using univariate and multivariate models and generated medical, psychiatric, and social multimorbidity indices.
  
  
  RESULTS
  Forty-four (29%) of the 151 participants were defined as frequent ED users, accounting for 81% of the 227 ED visits. Frequent ED users were more likely than infrequent or nonusers to be female; have chronic medical illnesses that included seizures, asthma, and migraines; and have worse physical health-related quality of life (HRQoL). In multivariate Poisson regression models, frequent ED use was associated with lower physical HRQoL (odds ratio [OR] = 0.95, p = 0.02) and having not had prerelease discharge planning (OR = 3.16, p = 0.04). Frequent ED use was positively correlated with increasing psychiatric multimorbidity index values.
  
  
  CONCLUSIONS
  Among released prisoners with HIV, frequent ED use is driven primarily by extensive comorbid medical and psychiatric illness. Frequent ED users were also less likely to have received prerelease discharge planning, suggesting missed opportunities for seamless linkages to care.
authors.affiliation: Department of Medicine, Section of Infectious Diseases, AIDS Program, Yale University School of Medicine, New Haven, CT, USA. jaimie.meyer@yale.edu
authors.forename: Jaimie P
authors.initials: JP
authors.lastname: Meyer
authors.forename: Jingjun
authors.initials: J
authors.lastname: Qiu
authors.forename: Nadine E
authors.initials: NE
authors.lastname: Chen
authors.forename: Gregory L
authors.initials: GL
authors.lastname: Larkin
authors.forename: Frederick L
authors.initials: FL
authors.lastname: Altice
mesh_terms: D000328:Adult; D000367:Age Factors; D015897:Comorbidity; D016001:Confidence Intervals; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D015658:HIV Infections / Q000453:epidemiology* / Q000503:physiopathology / Q000628:therapy*; D006300:Health Services Misuse / Q000706:statistics & numerical data*; D006801:Humans; D015994:Incidence; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D016012:Poisson Distribution; D011329:Prisoners / Q000706:statistics & numerical data; D011446:Prospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D012737:Sex Factors; D012959:Socioeconomic Factors; D014481:United States; D035862:Vulnerable Populations / Q000706:statistics & numerical data