Nurse practitioners in a jailhouse clinic

Six primary nurse practitioners were introduced into a large urban jail health service along with supportive organizational changes. The system's primary care volume capacity doubled. The average cost of each patient visit decreased by about one third. The technical quality of primary care improved continuously during a 3-year period of study while patient outcomes, patient satisfaction levels and overall mortality rates remained unchanged. The inmate suicide rate decreased after the introduction of a psychiatrically directed screening and treatment program, and cardiopulmonary resuscitation (CPR) training for correctional officers. Attribution of the decrease awaits further experience. The nurse practitioners delivered primary care equal in technical quality of care provided by medical subspecialty Fellows. A test of clinical knowledge proved to be a good predictor of the technical quality of care delivered by individual graduate nurse practitioners. One measure of the quality of management of illness episodes in the jail clinic correlated weakly with two measures of patient outcome. The addition of nurse practitioners into a well-organized, well-monitored jail health program was a cost-effective means of expanding the program's patient volume capacity. Screening and referral of inmates with high suicide potential, coupled with CPR training for correctional officers, may have been a factor in reducing the inmate suicide rate.