title: Emergency department utilization among recently released prisoners: a retrospective cohort study.
abstract: BACKGROUND
  The population of ex-prisoners returning to their communities is large. Morbidity and mortality is increased during the period following release. Understanding utilization of emergency services by this population may inform interventions to reduce adverse outcomes. We examined Emergency Department utilization among a cohort of recently released prisoners.
  
  
  METHODS
  We linked Rhode Island Department of Corrections records with electronic health record data from a large hospital system from 2007 to 2009 to analyze emergency department utilization for mental health disorders, substance use disorders and ambulatory care sensitive conditions by ex-prisoners in the year after release from prison in comparison to the general population, controlling for patient- and community-level factors.
  
  
  RESULTS
  There were 333,369 total ED visits with 5,145 visits by a cohort of 1,434 ex-prisoners. In this group, 455 ex-prisoners had 3 or more visits within 1 year of release and 354 had a first ED visit within 1 month of release. ED visits by ex-prisoners were more likely to be made by men (85% vs. 48%, p < 0.001) and by blacks (26% vs. 16%, p < 0.001) compared to the Rhode Island general population. Ex-prisoners were more likely to have an ED visit for a mental health disorder (6% vs. 4%, p < 0.001) or substance use disorder (16%vs. 4%, p < 0.001). After controlling for patient- and community-level factors, ex-prisoner visits were significantly more likely to be for mental health disorders (OR 1.43; 95% CI 1.27-1.61), substance use disorders (OR 1.93; 95% CI 1.77-2.11) and ambulatory care sensitive conditions (OR 1.09; 95% CI 1.00-1.18).
  
  
  CONCLUSIONS
  ED visits by ex-prisoners were significantly more likely due to three conditions optimally managed in outpatient settings. Future work should determine whether greater access to outpatient services after release from prison reduces ex-prisoners' utilization of emergency services.
authors.affiliation: Division of General Internal Medicine, Alpert Medical School of Brown University/Rhode Island Hospital, 111 Plain Street Building, Providence, RI 02903, USA. josephwfrank@gmail.com.
authors.forename: Joseph W
authors.initials: JW
authors.lastname: Frank
authors.forename: Christina M
authors.initials: CM
authors.lastname: Andrews
authors.forename: Traci C
authors.initials: TC
authors.lastname: Green
authors.forename: Aaron M
authors.initials: AM
authors.lastname: Samuels
authors.forename: T Tony
authors.initials: TT
authors.lastname: Trinh
authors.forename: Peter D
authors.initials: PD
authors.lastname: Friedmann
mesh_terms: D000328:Adult; D000553:Ambulatory Care; D016208:Databases, Factual; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005006:Ethnicity / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011329:Prisoners / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012237:Rhode Island; D012737:Sex Factors; D019966:Substance-Related Disorders / Q000628:therapy*; D013997:Time Factors; D055815:Young Adult