plan of care, or as clinically warranted. Additionally, periodic health assessment might be performed as a part of health care maintenance on or near the one‐year anniversary of incarceration, where applicable. All aspects of clinical services related to periodic health assessments should be addressed by written policy and defined procedures. CQI efforts should include, but not be limited to, compliance with policies and procedures and identifying opportunities for improvement of health assessments, including any training needs. Chronic Care A codified approach to managing chronic conditions is an essential component of correctional and community health care. CT DOC providers treat chronic conditions and do comply with some clinical guidelines, but not within a structure that allows for measurement of process or outcomes. Key shortcomings in chronic care noted include the following: · Chronic care is delivered to patients as they present; this is a reactive approach to care, which fails to use scheduled interventions to deliver the necessary level of control. · While there is some diabetes care data collected statewide, the data is under‐developed and not formatted to be actionable and drive improvement. · Chart reviews noted many diabetic patients did not receive (no documentation) foot assessments or eye exams according to broadly accepted clinical guidelines. Each identified chronic illness should have an associated clinical protocol and process for patient management. All identified patient diagnoses should be documented in the master problem list of the EHR when identified or diagnosed. There should also be a documentation tool in the form of a template within the EHR that provides embedded clinical decision support with adaptable order sets to allow the clinician to create an individualized care and treatment plan grounded in best practice around the management of chronic diseases. A physician or other qualified provider will develop, and update when warranted, individualized care and treatment plans at the time the condition is identified. The template may include the following: · Plan of care that includes patient goals · Mechanism to identify and place patients in chronic disease‐specific registries · Frequency of follow‐up for medical evaluation based on disease control and in accordance with national clinical guidelines · Monitoring the patient’s condition (e.g., poor, fair, good), status, and trends and taking appropriate action to improve patient outcomes · Type and frequency of diagnostic testing and therapeutic regimens (e.g., diet, labs, exercise, medication) · Documentation of patient education (e.g., diet, exercise, medication) · Compliance with clinical guidelines for disease management o Clinically justifying any deviation from the protocol Recommendation Recommendation 19 · Tracking of compliance with clinical guidelines by facility and provider, with appropriate remediation of variance Patient education, health literacy, and self‐management skills are critically important to improving health outcomes for people with chronic diseases. It is estimated that approximately 95% of the treatment of chronic illness occurs outside of the patient‐ provider interaction, underscoring the need for good self‐management skills. A program for health education for patients with chronic disease can be developed adapting best practice models to the jail settings. Topics may include basic knowledge of disease and medications, diet and exercise, recognizing change in condition, goal setting, myths and barriers to adherence, addressing health care, and connecting to community providers. The EHR documentation tools can create discrete data points that allow CT DOC to run reports that will assist in a robust quality program around the identification and management of chronic diseases for patients within the detention/prison facility. Lastly, CT DOC would benefit from having one policy that addresses the structure of the chronic care program at the facility level, inclusive of treatment protocols and guidelines. Infirmary Care NCCHC defines infirmary care as care “provided to patients with an illness or diagnosis that requires daily monitoring, medication, and/or therapy, or assistance with activities of daily living at a level needing skilled nursing interventions.” Further, NCCHC requires that “infirmary patients always be within sight and sound of a qualified health care professional.” We reviewed the related policy 8.1.9 Infirmary Care Services prior to our chart review and found all aspects of infirmary care, from admission to discharge, are not clearly defined. There is also variability in the approach to infirmary care and services at the facilities providing this level of care. In CT DOC, statewide infirmary bed management, a critical component of UM in a prison system, appears to be absent. We find CT DOC infirmaries function more as locations and as inmate overflow space, rather than a level of care to address clinical need. This is contrary to the best practice of prisons and jails, which use infirmaries to monitor patients whose clinical acuity is increasing and may, if not managed, require the need for inpatient hospital services. The infirmary is also used to serve patients who are returning from the hospital and no longer need inpatient care but are not yet stable or appropriate for general