Assessing chronic disease care in corrections

Background: Healthcare is constitutionally guaranteed in US prisons. However, there have been limited evaluations as to how well prison health systems are caring for patients with chronic conditions. We aimed to describe how clinical staff and administrators rate chronic disease care in prisons using a newly adapted instrument. Methods: We administered the Assessment of Chronic Illness Care-Prison (ACIC-P) to clinical staff and administrators of two northeastern prison systems. The ACIC-P was adapted from a validated instrument that assesses how well community healthcare organizations provide care, the Assessment of Chronic Illness Care instrument. It measures 6 components of chronic disease care in prisons: self-management support, linkages to community resources (including discharge planning), decision support, delivery system design, clinical information systems, and organization of the health system (including the role of corrections). Items within each component are scored between 0 and 11, where 0-2 = limited; 3-5= basic; 6-8 = reasonably good; and 9-11 = fully developed, chronic illness care. We describe measures of internal consistency, mean ACIC-P scores, and compared scores by those providing direct patient care, and length of practice in prison health using nonparametric tests. Results: Fifty-seven ACIC-P surveys have been completed, for a response rate of 62%. The mean age of respondents was 48.7 ± 9.8 years; 31 (54%) were women; 41 (72%) identified as White; and 42 (74%) clinical staff. Overall, respondents perceived prison systems,offer basic support for chronic illness care (ACIC-P score= 5.5 ±1.5). Internal consistency as represented by Cronbach's alpha ranged from “questionable” for the clinical linkages subscale to “good” for the organization of the health system. Both systems are viewed as providing “reasonably good” support for chronic illness care in terms of clinical linkages (6.7 ±1.7) and organization of the health system (6.3 ± 1.8), but only ‘basic support' with respect to self-management support (4.5 ± 2.1), clinical information systems (5.0 ± 2.1), decision support (5.5±1.9), and delivery system design (5.9±1.8). Administrators reported higher scores (reasonably good support) for organization of the health system, decision support, delivery system design and clinical information systems compared to clinical providers (basic support). There was a strong positive correlation between length of practice in prison health and ACIC-P score (ρ=0.42, p<0.01). Conclusion: Prison health staff and administration in the two states are providing basic chronic illness care and can improve in realms of patient self-management support, clinical information systems, decision support, and delivery system design.