title: A patient navigation intervention for drug-involved former prison inmates.
abstract: BACKGROUND
  Former prison inmates experience high rates of hospitalizations and death during the transition from prison to the community, particularly from drug-related causes and early after release. The authors designed a randomized controlled trial (RCT) of patient navigation to reduce barriers to health care and hospitalizations for former prison inmates.
  
  
  METHODS
  Forty former prison inmates with a history of drug involvement were recruited and randomized within 15 days after prison release. Participants were randomized to receive 3 months of patient navigation (PN) with facilitated enrollment into an indigent care discount program (intervention) or facilitated enrollment into an indigent care discount program alone (control). Structured interviews were conducted at baseline, 3 months, and 6 months. Outcomes were measured as a change in self-reported barriers to care and as the rate of health service use per 100 person-days.
  
  
  RESULTS
  The mean number of reported barriers to care was reduced at 3 and 6 months in both groups. At 6 months, the rate of emergency department/urgent care visits per 100 person-days since baseline was 1.1 among intervention participants and 0.5 among control participants (P = .04), whereas the rate of hospitalizations per 100 person-days was 0.2 in intervention participants and 0.6 in control participants (P = .04).
  
  
  CONCLUSIONS
  Recruitment of former inmates into an RCT of patient navigation was highly feasible, but follow-up was limited by rearrests. Results suggest a significantly lower rate of hospitalizations among navigation participants, although the rate of emergency department/urgent care visits was not improved. Patient navigation is a promising, pragmatic intervention that may be effective at reducing high-cost health care utilization in former prison inmates.
authors: a Division of General Internal Medicine , University of Colorado School of Medicine , Aurora , Colorado , USA.
authors: Ingrid A
authors: IA
authors: Binswanger
authors: Elizabeth
authors: E
authors: Whitley
authors: Paul-Ryan
authors: PR
authors: Haffey
authors: Shane R
authors: SR
authors: Mueller
authors: Sung-Joon
authors: SJ
authors: Min
mesh_terms: D000328:Adult; D003120:Colorado; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006297:Health Services Accessibility; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D057187:Independent Living; D008297:Male; D008875:Middle Aged; D062526:Patient Navigation / Q000379:methods*; D011329:Prisoners; D019966:Substance-Related Disorders / Q000534:rehabilitation*; D017664:Uncompensated Care; D035862:Vulnerable Populations
keywords: Health care utilization; patient navigation; prisoners; randomized controlled trials; substance abuse; vulnerable populations