Correctional Health Care Establishes Itself as an Industry Model
Jackson, Mike, Corrections Today
It is a great time to be in correctional health care. In just a few decades, the field has developed from nonexistence into an evidence-based, collaborative, integrated structure with outcomes that rival the best available anywhere. There is much work yet to be done, but as the articles in this issue show, there is also much to be proud of.
It comes as no surprise to anyone working in this field that we in corrections inherit the most challenging individuals society has to offer in terms of physical and mental health. Higher burdens of infectious diseases are well-documented. Chronic illnesses that receive, at best, episodic care and, more often, no care at all prior to reaching our gates are the norm. Patients with severe mental illness, for whom care was desperately needed but inaccessible, find themselves inside the walls of our institutions.
What many may find surprising, though, are the excellent clinical outcomes now being achieved by correctional health care professionals. In Oklahoma, a recent look at clinical outcomes demonstrated this clearly. Using outcome measurements defined by the Agency for Healthcare Research and Quality (ARHQ) and the CDC's Healthy People 2010 Database, we looked at how we are doing compared to national benchmarks. Take diabetes control for example. In our population, the percentage of individuals with diabetes whose most recent Hgb[A.sub.1]C was less than 7, was 46 percent. The 2006 National Healthcare Quality Report by AHRQ puts the national figure at 39.8 percent. Similarly, for blood pressure control (<140/90 among individuals diagnosed with hypertension), the Healthy People 2010 goal is 50 percent of the population at or below goal. In our population 67 percent of individuals with hypertension have achieved blood pressure control. The third National Health and Nutrition Examination Survey (NHANES III) revealed that only 15 percent of individuals with Coronary Artery Disease (CAD) had their LDL cholesterol at target (<100 mg/dl at that time). In our system, 60 percent of CAD patients have reached that goal LDL level.
I'm not just bragging about Oklahoma here. Other correctional medical directors I've talked to are seeing similar striking clinical outcomes. Among a population that comes to us in the worst possible shape, how is this happening? In my mind, it is attributable to three factors: a strong primary care foundation, evidence-based preventive care and chronic disease management, and a spirit of collaboration.
During the past few decades, primary care in the "free world" has experienced an erosion of support as health insurers and other payors reward a high-tech, specialty-based health care system. This approach comes at quite a cost--not only financially, but in terms of health care quality. In many cases, as a nation, we are quite far from the Healthy People 2010 goals for disease control and adherence to evidence-based treatment guidelines, and there are only two more years to get there. …