Journal of Correctional Health Care - April 2023 - 118

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AGGARWAL AND WILL
Table 3. Multivariable Logistic Regression Analyses of Relationship to Primary Care and Acute Care Access (N= 706)
Characteristics
PC
Adjusted odds ratio (95% CI)
Male (vs. female)
Age
Race (vs. White)
Black
Hispanic/Latino
Asian
Other/unknown
Medical diagnosis
Behavioral diagnosis
0.572 (0.360-0.911)
0.964 (0.822-1.131)
0.722 (0.281-1.860)
1.045 (0.587-1.863)
1.662 (0.620-4.458)
1.400 (0.499-3.926)
1.377 (0.840-2.256)
2.636 (1.663-4.180)
to be readmitted than those who did not. This remained
true even when controlling for any known medical or
behavioral health diagnosis.
Furthermore, youth with known behavioral health
diagnoses were more likely to access both PC and AC
services after discharge. The results suggest a relationship
between juvenile detention, health care utilization,
and the likelihood of readmission. They further support
the importance of establishing a medical home and PC
use as established care appears to support continuation
of care after detention.
Although the causes of juvenile justice involvement
are multifactorial, the results of this study suggest that
a relationship exists between PC utilization after release
and repeat detention. We found that youth who had an
identified behavioral health diagnosis were approximately
2.5 times more likely to be readmitted within the
study window and youth with a medical diagnosis were
approximately 2 times more likely to be readmitted
compared to those who did not have a diagnosis listed
on their problem list. It is unclear if those youth who
had behavioral health or medical diagnoses were at inp
.018
.657
.501
.880
.313
.522
.205
<.001
AC
Adjusted
odds ratio (95% CI)
0.714 (0.471-1.084)
0.941 (0.819-1.082)
1.059 (0.502-2.231)
1.031 (0.622-1.709)
0.652 (0.228-1.864)
1.439 (0.593-3.490)
1.159 (0.743-1.808)
2.111 (1.396-3.193)
p
.114
.395
.881
.907
.425
.420
.516
<.001
creased risk for certain high-risk behaviors and therefore
more prone to readmission. It is assumed that those who
did not have a listed diagnosis had no identified medical
or behavioral health diagnosis and therefore fewer medical
and mental health needs.
Some youth were not readmitted during the study
period and accessed PC and AC after 90 days. This warrants
further investigation. It is unclear if these youth
had fewer medical and behavioral health diagnoses and
therefore less medical and mental health need or other
referral needs that could be facilitated through the PC
office. The complexity of the cyclical relationship among
medical and mental health needs, health care utilization,
and juvenile detention requires further exploration.
This study is limited as we did not include insurance
status, access to transportation, or data from non-EHR
linked clinics. Within the county, there are no data that
detail the number of PC clinics that use the same EHR;
however, there is limited data for Medicare EHR Incentive
Program eligible providers. Approximately 90% of
family practice, internal medicine, and pediatric providers
did use Epic and would be on the existing data
Fig. 1. Cumulative
readmission over time.

Journal of Correctional Health Care - April 2023

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