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Evaluating the Effects of NCCHC Accreditation on Health Care in U.S. Jails

Last registered on June 08, 2023
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Pre-Trial

Trial Information

General Information

Title
Evaluating the Effects of NCCHC Accreditation on Health Care in U.S. Jails
RCT ID
AEARCTR-0007516
Initial registration date
April 08, 2021

Initial registration date is when the trial was registered.

It corresponds to when the registration was submitted to the Registry to be reviewed for publication.

First published
April 08, 2021, 6:18 AM EDT

First published corresponds to when the trial was first made public on the Registry after being reviewed.

Last updated
June 08, 2023, 9:44 AM EDT

Last updated is the most recent time when changes to the trial's registration were published.

Locations

Country
United States of America
Region

Primary Investigator

Name
Crystal Yang
Affiliation
Contact Primary Investigator

Other Primary Investigator(s)

PI Name
Marcella Alsan
PI Affiliation
Harvard Kennedy School
Contact Investigator

Additional Trial Information

Status
In development
Start date
2021-06-20
End date
2024-06-20
Keywords
Crime, Violence, & Conflict, Health
Additional Keywords
JEL code(s)
Secondary IDs
Prior work
This trial is based on or builds upon one or more prior RCTs.
Abstract
Jails admit nearly 11 million individuals each year, including a high number of inmates with mental illnesses, infectious diseases, and chronic diseases. Since the Supreme Court’s landmark decision in Estelle v. Gamble (1976), federal and state correctional systems (including prisons, jails, and juvenile detention facilities) have been constitutionally mandated to provide “reasonably adequate” health care to the incarcerated population. Yet, unlike health care systems that provide services to the nonincarcerated population, there is no legally-mandated accreditation system for health care provided in U.S. correctional systems, including jails. As a result, jails may struggle to provide needed health care services. This may result in increased morbidity and mortality in this vulnerable population. Jail reforms are also often piecemeal and in response to inmate litigation. In this study, we propose to randomize the offer of health care accreditation via the National Commission on Correctional Health Care (NCCHC) to 40 medium-sized jails. NCCHC, the organization that pioneered standards for jail health care services, operates a voluntary accreditation program based on a set of consensus-driven standards that provide a framework for the care inmates receive. We hypothesize that the process of preparation, verification, and maintenance of accreditation will improve health care processes, inmate health outcomes, and satisfaction and retention among correctional staff, and potentially reduce recidivism, litigation, and health care costs for jails.
External Link(s)

Registration Citation

Citation
Alsan, Marcella and Crystal Yang. 2023. "Evaluating the Effects of NCCHC Accreditation on Health Care in U.S. Jails ." AEA RCT Registry. June 08. https://doi.org/10.1257/rct.7516-2.0
Sponsors & Partners

Sponsors

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Experimental Details

Interventions

Intervention(s)
We will partner with NCCHC, the oldest correctional health care accrediting body in the U.S. NCCHC grew out of a program of the American Medical Association in the early 1970s with a goal of understanding and improving health care for inmates, Our intervention, the accreditation of jails, is based on the NCCHC Standards for Health Services in Jails. These standards are widely accepted by the health, legal, and corrections professions. The seven sections of the standards cover the following areas: governance and administration; health promotion, safety, and disease prevention; personnel and training; ancillary health care services; patient care and treatment; special needs and services; and medical-legal issues.


Intervention (Hidden)
Intervention Start Date
2021-06-20
Intervention End Date
2023-11-01

Primary Outcomes

Primary Outcomes (end points)
Meeting protocol standards; health outcomes, with particular attention to outcomes related to mental health and substance use disorders; recidivism as measured by re-arrest, re-conviction and/or return to jail or prison; health care costs; engagement, coordination, and satisfaction of healthcare staff; inmate appraisal of health services.
Primary Outcomes (explanation)

Secondary Outcomes

Secondary Outcomes (end points)
Secondary Outcomes (explanation)

Experimental Design

Experimental Design
In this study, we plan to rigorously investigate the impact of accreditation by conducting a staggered encouragement RCT. We will randomly assign half of the sample to obtain accreditation by going through the NCCHC process immediately and half of the sample to control (i.e., business as usual without accreditation) until 14 months after enrollment. Randomly assigning accreditation processes conditional on willingness to obtain accreditation will enable us to purge our estimates of selection bias.

We plan to build off the existing NCCHC accreditation surveys to conduct a baseline survey, which will contain information such as jail capacity, ADP, inmate demographics, size and composition of health staff, and prevalence of inmate health conditions. We will use this baseline survey to assess randomization balance. The surveys will be conducted on site by Harvard-employed staff so that they can be completely similar in treatment and control locations and independent.
Experimental Design Details
Randomization Method
We will randomly assign half of the sample to obtain accreditation by going through the NCCHC process immediately and half of the sample to control (i.e., business as usual without accreditation). Facilities in the control group will be able to undergo the accreditation process following the final survey. Randomly
assigning accreditation processes conditional on willingness to obtain accreditation will enable us to purge our estimates of selection bias. We may stratify by facility size, location, and whether or not the facility has a private healthcare vendor.
Randomization Unit
no jail
Was the treatment clustered?
No

Experiment Characteristics

Sample size: planned number of clusters
40 jails
Sample size: planned number of observations
40 jails
Sample size (or number of clusters) by treatment arms
20 jails control, 20 jails treatment
Minimum detectable effect size for main outcomes (accounting for sample design and clustering)
Supporting Documents and Materials
IRB

Institutional Review Boards (IRBs)

IRB Name
Harvard Human Research Protection Program
IRB Approval Date
2021-05-19
IRB Approval Number
IRB21-0470
Analysis Plan

Analysis Plan Documents

AccredStudy PAP

MD5: 1d5d211e52cbde9eab163ff975054476

SHA1: e26afae1688f6fe8b919aac416fd74b00740d311

Uploaded At: November 01, 2021

Post-Trial

Post Trial Information

Study Withdrawal

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Intervention

Is the intervention completed?
No
Data Collection Complete
Data Publication

Data Publication

Is public data available?
No

Program Files

Program Files
Reports, Papers & Other Materials

Relevant Paper(s)

Reports & Other Materials