Incarcerated Patients Presenting to an Academic Emergency Department: A Retrospective Review Using Payor Source for...

Emergency departments (EDs) serve an important role in the care of patients who are imprisoned (incarcerated) in the federal and state prison systems, and the University of North Carolina Healthcare (UNCH) System helps provide care to these patients. Our aim was to identify and characterize this marginalized patient population by payer source, compare it with the general ED population, and, ultimately, seek ways to improve ED and follow-up care.

This was a hypothesis-generating study utilizing two separate ED sites: a tertiary referral academic ED and a smaller, academically affiliated community hospital. Retrospective data were sourced from the Epic Electronic Health Record via the Carolina Data Warehouse for Health, part of the North Carolina Translational and Clinical Sciences Institute. All ED encounters involving incarcerated individuals were obtained from January 1, 2018, through December 31, 2024. Inmate encounters were identified via a distinct payer source, the NC Department of Public Safety. Descriptive statistics, including means and percentages, were generated using Python (Python Software Foundation, Beaverton, Oregon) and pandas (The pandas development team, NumFOCUS, Austin, Texas).

A total of 555 encounters involving 478 unique patients were identified. The majority of patients presenting from NC prison facilities were male (92.4% of encounters), compared with 43.7% of ED patients overall. The average age was similar (46.4 versus 49.7 years), but a smaller proportion of patients from prison were younger (18-24 years old) or older (over 65 years old). A higher percentage of patients presenting from prison were identified as Black or African American (44.9% versus 29.6%). The most common chief complaints were abdominal pain, chest pain, and "abnormal lab," compared with abdominal pain, chest pain, and shortness of breath in the general ED population.

Challenges exist in retrospectively identifying incarcerated patients in the ED for research. Using a distinct payer source, we identified and characterized a cohort of incarcerated patients and compared them with other ED patients. Future work will investigate how to improve ED and follow-up care for this unique patient population.