Second, specific ACA provisions are expected to improve access and fragmentation within the nation’s mental health and substance use disorder treatment systems [39]. The healthcare utilization seen in this study suggests that the nation’s criminal justice system

offers a high-yield point of contact for the state and federal agencies responsible for enrolling newly eligible individuals in coverage. Such targeted enrollment could facilitate access to the ambulatory care among this high-risk group, potentially impacting need for ED services and thereby ED overcrowding. Additionally, future work should seek to determine the impact of recent legislation on access, utilization Inhibitors,research,lifescience,medical and health outcomes among the nation’s criminal justice populations. This study should be interpreted in the context of its limitations. ED Inhibitors,research,lifescience,medical utilization was limited to visits occurring in a single hospital network in the

state of Rhode Island and may not be generalizable to other settings. Our study did not capture visits at other hospitals in Rhode Island or in neighboring states nor does it account for visits to community-based Inhibitors,research,lifescience,medical sites such as urgent care centers. Lacking these data likely would have underestimated the number of ED visits by the study population. Thus, we can be confident that the observed associations are as high or higher than estimated. Data limitations resulting from de-identification of ex-prisoner data as well as those inherent in data from the Rhode Island Department of Health prevented linkage of visits by specific individuals over time or Inhibitors,research,lifescience,medical between hospitals. Our main analyses therefore compare diagnosis-specific proportions of health care utilization of Rhode Island’s ex-prisoner population to that of the state’s general population. Further study should seek to better characterize rates of utilization over time by ex-prisoner Inhibitors,research,lifescience,medical populations. The description of the case mix in our study is limited by its reliance on ICD-9 coding and absence of a more detailed chart review. As only primary ICD-9 codes were used,

we are unable to identify those ED visits in which diagnoses of interest were not made or documented by the GSK-3 assay treating physician. Thus, the true impact of mental health disorders, substance use disorders and else ambulatory care sensitive conditions is likely underestimated. Finally, we were unable to identify the ex-prisoner population within the Department of Health dataset. Due to the differences in size between the two groups, any impact on our findings would be minimal and would bias results toward the null. Conclusions Emergency department visits by ex-prisoners within 1 year of release from prison were significantly more likely to be related to mental health disorders, substance use disorders and ambulatory care sensitive conditions. Each of these conditions is optimally managed with community-based, ambulatory services.