Thirty-day readmission after medical-surgical hospitalization for people who experience imprisonment in Ontario, Canada: A retrospective cohort study.

Fiona G Kouyoumdjian,Aaron M Orkin,Kinwah Fung,Stephanie Y Cheng,Ji Yun Lee,Gordon Guyatt,Tim O’Shea,Lars-Peter Kamolz

doi:10.1371/journal.pone.0227588

Abstract

We aimed to compare 30-day readmission after medical-surgical hospitalization for people who experience imprisonment and matched people in the general population in Ontario, Canada. We used linked population-based correctional and health administrative data. Of people released from Ontario prisons in 2010, we identified those with at least one medical or surgical hospitalization between 2005 and 2015 while they were in prison or within 6 months after release. For those with multiple eligible hospitalizations, we randomly selected one hospitalization. We stratified people by whether they were in prison or recently released from prison at the time of hospital discharge. We matched each person with a person in the general population based on age, sex, hospitalization case mix group, and hospital discharge year. Our primary outcome was 30-day hospital readmission. We included 262 hospitalizations for people in prison and 1,268 hospitalizations for people recently released from prison. Readmission rates were 7.7% (95%CI 4.4-10.9) for people in prison and 6.9% (95%CI 5.5-8.3) for people recently released from prison. Compared with matched people in the general population, the unadjusted HR was 0.72 (95%CI 0.41-1.27) for people in prison and 0.78 (95%CI 0.60-1.02) for people recently released from prison. Adjusted for baseline morbidity and social status, hospitalization characteristics, and post-discharge health care use, the HR for 30-day readmission was 0.74 (95%CI 0.40-1.37) for people in prison and 0.48 (95%CI 0.36-0.63) for people recently released from prison. In conclusion, people recently released from prison had relatively low rates of readmission. Research is needed to elucidate reasons for lower readmission to ensure care quality and access.

Highlights

In recent years, there has been a substantial focus on readmission after hospitalization as an indicator of quality of care [1]
We identified matches in the general population for 1,548 people: 262 of whom were discharged from hospital to prison, whom we called people in prison, and 1,286 of whom were discharged from hospital to the community, whom we called people recently released from prison
People in prison and people recently released from prison were more likely than people in the general population to live in a neighbourhood in the lowest income quintile, and had greater morbidity at the time of the index hospitalization, as indicated by the median number of Aggregated Diagnosis Groups (ADGs) and certain mental disorder diagnoses (Table 1)

Summary

Introduction

There has been a substantial focus on readmission after hospitalization as an indicator of quality of care [1]. Readmission rates may reflect baseline morbidity, the development of new conditions or progression of chronic conditions, access to hospital care, inpatient mortality rates, and post-discharge mortality rates [2,3,4,5]. An elevated rate of readmission is assessed as an indicator of deficiencies in quality of hospital care such as incomplete treatment, medical error, and inadequate discharge planning [2, 6, 7]. The period after release from prison is associated with high morbidity and mortality, with several studies showing increased rates of medical-surgical hospitalization compared to the general population [9,10,11,12,13,14,15,16,17,18]. Health care access and quality may be suboptimal for this population while in prison and after prison release [13, 19], with substantial impacts on individual and population health [20]

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