Nurse practitioners in a jailhouse clinic

Area of Science:

• Health Services Research
• Nursing Practice
• Correctional Healthcare

Background:

• Jail health services face challenges in managing primary care volume and costs.
• The integration of advanced practice providers, like nurse practitioners, is a potential strategy to address these challenges.
• Evaluating the impact of such integration on quality, cost, and patient outcomes is crucial for evidence-based practice.

Purpose of the Study:

• To assess the impact of introducing primary nurse practitioners (NPs) into a large urban jail health service.
• To evaluate changes in primary care volume capacity, cost-effectiveness, technical quality of care, patient outcomes, and mortality rates.
• To explore potential factors influencing the inmate suicide rate.

Main Methods:

• Implementation of six primary nurse practitioners within the existing jail health service.
• Inclusion of supportive organizational changes and a psychiatrically directed screening and treatment program.
• Provision of cardiopulmonary resuscitation (CPR) training for correctional officers.
• Continuous monitoring and evaluation over a 3-year study period.

Main Results:

• Primary care volume capacity doubled, and the average cost per patient visit decreased by approximately one-third.
• Technical quality of primary care improved continuously; patient outcomes, satisfaction, and overall mortality rates remained unchanged.
• The inmate suicide rate decreased following the introduction of the screening/treatment program and CPR training.

Conclusions:

• The addition of nurse practitioners was a cost-effective method for expanding patient volume capacity in a well-organized jail health program.
• Nurse practitioners provided primary care of technical quality comparable to medical subspecialty fellows.
• Screening for suicide risk and CPR training may have contributed to the reduction in inmate suicides, warranting further investigation.