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CDCR Study Yields ‘Starter Set’ of Prison Health Care Quality Measures

The California prison health care system has received a lot of attention in the past several years and produced shock waves when it was put into federal receivership in 2005. But as the receiver’s turnaround plan has progressed, the reports are increasingly positive, showing steadfast commitment to improvement and measurable goals for achieving it. For instance, the five-year strategic plan issued last summer sets a goal of bringing 90% of the prison system’s health care programs into compliance with NCCHC standards for health services.

Another significant initiative is described in the April 2011 issue of the Journal of Correctional Health Care. In a special three-part section, a team of researchers from the RAND Corporation highlight a project conducted at the request of the California Department of Corrections and Rehabilitation to help it establish a sustainable quality measurement program that will aid with ongoing accountability and quality improvement efforts.

In this project, which took place during 2008 and 2009, RAND was charged with three tasks:

1. Assess the current clinical quality measurement approaches in CDCR

2. Survey the clinical quality measurement approaches being used by leading state prison systems and the Federal Bureau of Prisons

3. Recommend access and clinical quality measures to form the basis of a “starter set” of performance measures

The first article examines the current state of access to care and quality measurement in the CDCR, as well as assessing strengths and weaknesses of current activities. This entailed conducting interviews and site visits in the CDCR and related offices, along with document reviews. Key findings were that although the CDCR’s quality efforts do focus on pertinent issues—defined in this study as clinical effectiveness, timeliness (access) and patient centeredness—few explicit, evidence-based quality of care measures are being used. Instead, many of the current measures represent policies and procedures with vague specifications that are hard to apply uniformly and are not evidence-based.

The second task was to identify existing indicators of quality performance and to recommend a set of indicators applicable to the California prison population. The study took an environmental scan of quality measures used by the BOP and five state correctional systems, and examined what dimensions (such as clinical quality, patient experience, access to care and patient safety) and clinical areas are the focus. Barriers and facilitators to quality measurement are also explored in this article. Findings revealed substantial variation in the number and type of measures being used and in the data systems used to construct measures. The various systems all included explicit quality measures but also measures of disease prevalence and standards.

Finally, the researchers identified tested indicators of clinical quality and access that prisons could use to identify performance gaps and guide improvement. A modified Delphi method was used to select the best indicators, which an expert panel then rated on validity and feasibility. The final 79 indicators (listed in an appendix) pertain to areas such as access, cardiac conditions, geriatrics, infectious diseases, medication monitoring, metabolic diseases, obstetrics/gynecology, screening/prevention, psychiatric disorders/substance abuse, pulmonary conditions and urgent conditions. With their explicit, well-defined denominators and numerators, this list provides a basic library of quality measures.

— About the authors: For access to these articles as well as a complete Journal archive, see JCHC online. Each issue also has a self-study exam by which physicians, nurses, psychologists, CCHPs and others may earn continuing education credit. Academy of Correctional Health Professionals members receive JCHC (print and online) as a benefit of membership.

[This article first appeared in the Winter 2011 issue of CorrectCare.]