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Health Care Delivery in the Texas Prison System:  The Role of Academic Medicine

Ben G. Raimer, MD; John D. Stobo, MD
JAMA. 2004;292(4):485-489. doi:10.1001/jama.292.4.485.
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Faced with explosive growth in its prison population and a legal mandate to improve medical care for incarcerated offenders, the state of Texas implemented a novel correctional managed health care program in 1994. The organizational structure of the program is based on a series of contractual relationships between the state prison system, 2 of the state's academic medical centers, and a separate governing body composed of 9 appointed members, which include 5 physicians. All medical, dental, and psychiatric care for more than 145 000 offenders, incarcerated under the jurisdiction of the Texas Department of Criminal Justice, is provided by the University of Texas Medical Branch and Texas Tech University Health Sciences Center. The health delivery system is composed of several levels of care, including primary ambulatory care clinics in each prison unit, 16 infirmaries at strategic locations throughout the state, several regional medical facilities, and a dedicated prison hospital with a full range of services. Specialized treatment programs have been established at various units for patients with chronic conditions, such as hypertension, diabetes mellitus, major psychiatric disorders, hepatitis, and human immunodeficiency virus infection. Significant improvements in health outcomes have occurred since the managed care program was established.

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Figure 1. Annual AIDS-Related Mortality Rate for TDCJ Population Before and After Implementation of Treatment Guidelines
Graphic Jump Location
TDCJ indicates Texas Department of Criminal Justice. The annual US mortality data in adolescents and adults with AIDS per 100 000 population between 1994 and 2000 were adapted from the Centers for Disease Control and Prevention.27 Dotted line indicates date of implementation of guidelines for human immunodeficiency virus disease management in incarcerated offenders within the TDCJ.
Figure 2. Annual Asthma Death Rate for TDCJ Population Before and After Implementation of Treatment Guidelines
Graphic Jump Location
TDCJ indicates Texas Department of Criminal Justice. The Texas asthma mortality rates from 1995 to 2002 were adapted from the Texas Department of Health28,29 and the US asthma mortality rates from 1996 to 2000 were adapted from National Vital Statistics Reports, Centers for Disease Control and Prevention.3034 Dotted line indicates date of implementation of guidelines for the management of acute and chronic asthma in incarcerated offenders within the TDCJ.

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