Capturing incarceration in the medical record: we cannot manage what we cannot measure

Nearly 2 million people are incarcerated in US jails and prisons, where they experience disproportionate burdens of chronic disease, mental illness, substance use disorders, and infectious diseases. Although many receive specialty or acute care in community hospitals, incarceration status is rarely captured in clinical or administrative data, rendering this population largely invisible to quality-improvement efforts, research, and health equity initiatives. Existing identification strategies-including International Classification of Diseases (ICD) codes capturing social determinants of health or institution-specific electronic medical record workarounds-are inconsistently used, lack specificity, and offer little reimbursement incentive, resulting in incomplete and nonstandardized data. Here we review current gaps in documenting incarceration within community medical centers and propose policy and infrastructure reforms to improve measurement and accountability, including reclassifying incarceration-related codes as reimbursable comorbid conditions to incentivize documentation, developing consensus guidance from professional societies to standardize practices, pairing data collection with ethical safeguards to mitigate stigma and misuse, and incorporating incarceration status into national administrative datasets to enable population-level research.