Abstract available in the JACC Cardiovascular Interventions.

The inmate population is increasing, aging and generally in poorer health than the non-incarcerated population. Providing healthcare to inmates is constitutionally mandated, and expensive. Little published research exists to assist corrections health policy makers strategically plan for future inmate healthcare needs. This research provides an extensive description of the healthcare utilization patterns of a sample of 577 male and female inmates incarcerated at state-operated prisons in Kentucky during the period January 1, 2007, to December 31, 2007 and who have at least one of the chronic conditions of diabetes, hypertension or hyperlipidemia. The primary outcome measures were a count of the number of encounters documented in the inmate‟s electronic health record by 1) medical doctors and advanced registered nurse practitioners (medical care utilization) and 2) psychiatrists and psychologists (mental healthcare utilization), and 3) a dichotomous variable indicating if the inmate had received care from a health provider located outside the prison. The explanatory variables included demographic variables, health status variables, health risk factors, sentence-related variables, facility characteristics, inmate to corrections and medical staff ratios and quality of care indicators. Differences in healthcare utilization between various groups of inmates were tested using Pearson‟s chi-squared test for categorical variables and Student t-test for continuous variables. In the bivariate analysis increasing age, being female, having comorbidities, having a diagnosis of mental illness, being obese, not adhering to diet, exercise and medications, refusing or missing treatment, being at a facility with more corrections or medical staff and having better quality of care were all associated with greater healthcare utilization. Negative binomial regression was used to analyze the count outcomes, and multivariate logistic regression analysis was used to analyze the dichotomous outcome. Regression analysis revealed that the number of problems an inmate had recorded in their electronic health record and increasing age were the two greatest predictors of within facility and secondary healthcare utilization. Carrying out case management and disease management for inmates with comorbidities may have benefits for Departments of Corrections and inmates.