Telehealth Support of Managed Care for a Correctional System: The Open Architecture Telehealth Model.

INTRODUCTION: The intent was to evaluate time to match initial investment of a new, statewide correctional system telehealth program based upon cumulative savings by avoidance of transportation and custody-related costs. MATERIALS AND METHODS: The setting was a statewide correctional system where prisoners received medical care through enhanced telemedicine technology supported by newly recruited specialty providers delivered through an open architecture system. The patients were incarcerated persons requiring nonemergent consultations in 10 specialties. A financial model was created to estimate transportation expenses, including vehicular use and custody staff, during the out of prison travel for traditional face-to-face care. Cost savings were then estimated by multiplying transportation expenses by the number of telehealth encounters (avoided cost) and summed cumulatively. Savings were mapped monthly. Private sector specialists were recruited, provided security clearance, trained in the use of the technology, and provided a secure site to provide services. MEASUREMENTS AND MAIN RESULTS: Based on the financial model, 1.2 million dollars in savings, equaling the initial capital investment, were achieved at 32 months. The total number of patient telemedicine encounters increased from 2,365 (±98/month) to 3,748 during the first 32 months of operation (July 2013 through January 2016: ±117/month) with 89% of the established specialties performed by telemedicine technologies. DISCUSSION: It was initially estimated to require 48 months to achieve the investment savings, but savings were achieved in 32 months, demonstrating greater adoption than expected. While finances were quantifiable, enhanced public safety by avoidance of out of prison time is unquantifiable, but judged to be significant.

Rapid HIV testing in large urban jails.

HIV prevalence is higher in jails than in the community, yet many jails do not conduct HIV testing. Jails in Baltimore, Maryland; Philadelphia, Pennsylvania; and the District of Columbia have implemented innovative rapid HIV testing programs. We have summarized the results of these programs, including the numbers of persons tested, rapid and confirmatory HIV test results, and numbers of persons newly diagnosed with HIV. We have described facilitators and challenges of implementation. These programs confirmed that rapid HIV testing in jails was feasible and identified undiagnosed HIV infection. Challenges included limited space to provide confidential rapid HIV testing and rapid turnover of detainees. Implementation required collaboration between local governments, health agencies, and correctional institutions. These programs serve as models for expanding rapid HIV testing in jails.

Tuberculosis control in a large urban jail: discordance between policy and reality.

OBJECTIVE: This study evaluated adherence to tuberculosis control guidelines, published by the Centers for Disease Control and Prevention in 1996, in a large urban jail. Jails are a critical locale because of high risk for tuberculosis transmission in a congregate setting. METHODS: Symptom screening at intake into the facility was systematically observed. Medical records were reviewed to measure timing of tuberculin skin testing (TST) and chest radiograph (CXR) screening. Isolation records were examined for airborne infectious isolation practices. Contact investigation practices were evaluated for ease of data retrieval and adherence to CDC guidelines. RESULTS: A TB symptom screening question was asked correctly during 28/97 of intake health interviews. Median time from intake to TST was 3 days for men and 2 days for women. Median time from referral to CXR was 2 days for men and 7 days for women. Delays were noted in diagnostic testing of 51 detainees isolated for suspected TB. Contact investigations lacked comprehensive procedures, data collection forms, and databases for managing information. CONCLUSION: Findings were used to refine protocols for TB control. This evaluation illustrated the need for ongoing assessment of adherence to TB control protocols in short-term correctional settings to prevent the spread of TB.

Prevalence, risk factors, and molecular epidemiology of methicillin-resistant Staphylococcus aureus among newly arrested men in Baltimore, Maryland.

BACKGROUND: Outbreaks of methicillin-resistant Staphylococcus aureus (MRSA) within prison populations seemingly attest to its spread within the corrections industry; however, the extent of MRSA colonization on arrest is unknown. METHODS: This study determined the prevalence and risk factors of S aureus on arrest. Nasal swabs from 602 newly arrested men were evaluated. Risk factors were assessed through self-report. Molecular characterization of each isolate was completed. RESULTS: The prevalence of S aureus nasal colonization was 40.4% (243/602). MRSA colonization was found in 15.8% (95/602) of the total population and in 39.1% (95/243) of the total S aureus isolates. Twenty-three skin infections were identified; of these, 11 (47.8%) were S aureus infections, with methicillin-susceptible S aureus (MSSA) in accounting for 3 cases (13.1%) and MRSA accounting for 8 cases (34.8%). In 2 cases (25%) of MRSA wound infection, the nasal colonizing strain was MSSA. By pulsed-field gel electrophoresis, 76 of 95 (80%) nasal isolates were found to be USA300 or related subtypes, with the other 19 (20%) being non-USA300 strains. The Panton-Valentine leukocidin gene was identified in 38 (97.4%) USA300 isolates and in 6 (31.6%) non-USA 300 isolates. CONCLUSION: MRSA colonization is far greater in this sample than in the general public. USA300 subtypes are highly prevalent. History of previous arrest was not associated with increased MRSA prevalence. MRSA risk factors differed significantly between those with and without a history of previous arrest.