PMID- 23690385
OWN - NLM
STAT- MEDLINE
DCOM- 20131017
LR  - 20240109
IS  - 1544-1717 (Electronic)
IS  - 1544-1709 (Print)
IS  - 1544-1709 (Linking)
VI  - 11 Suppl 1
IP  - Suppl 1
DP  - 2013 May-Jun
TI  - Process and outcomes of patient-centered medical care with Alaska Native people 
      at Southcentral Foundation.
PG  - S41-9
LID - 10.1370/afm.1474 [doi]
AB  - PURPOSE: This study describes key elements of the transition to a 
      patient-centered medical home (PCMH) model at Southcentral Foundation (SCF), a 
      tribally owned and managed primary care system, and evaluates changes in 
      emergency care use for any reason, for asthma, and for unintentional injuries, 
      during and after the transition. METHODS: We conducted a time series analyses of 
      emergency care use from medical record data. We also conducted 45 individual, 
      in-depth interviews with PCMH patients (customer-owners), primary care 
      clinicians, health system employees, and tribal leaders. RESULTS: Emergency care 
      use for all causes was increasing before the PCMH implementation, dropped during 
      and immediately after the implementation, and subsequently leveled off. Emergency 
      care use for adult asthma dropped before, during, and immediately after 
      implementation, subsequently leveling off approximately 5 years after 
      implementation. Emergency care use for unintentional injuries, a comparison 
      variable, showed an increasing trend before and during implementation and 
      decreasing trends after implementation. Interview participants observed improved 
      access to primary care services after the transition to the PCMH tempered by 
      increased staff fatigue. Additional themes of PCMH transformation included the 
      building of relationships for coordinated, team-based care, and the important 
      role of leadership in PCMH implementation. CONCLUSIONS: All reported measures of 
      emergency care use show a decreasing trend after the PCMH implementation. Before 
      the implementation, overall use and use for unintentional injuries had been 
      increasing. The combined quantitative and qualitative results are consistent with 
      decreased emergency care use resulting from a decreased need for emergency care 
      services due to increased availability of primary care services and same-day 
      appointments.
FAU - Driscoll, David L
AU  - Driscoll DL
AD  - Institute for Circumpolar Health Studies, University of Alaska Anchorage, 3211 
      Providence Dr, DPL 404, Anchorage, AK 99508, USA. DavidDriscoll@uaa.alaska.edu
FAU - Hiratsuka, Vanessa
AU  - Hiratsuka V
FAU - Johnston, Janet M
AU  - Johnston JM
FAU - Norman, Sara
AU  - Norman S
FAU - Reilly, Katie M
AU  - Reilly KM
FAU - Shaw, Jennifer
AU  - Shaw J
FAU - Smith, Julia
AU  - Smith J
FAU - Szafran, Quenna N
AU  - Szafran QN
FAU - Dillard, Denise
AU  - Dillard D
LA  - eng
GR  - R18 HS019154/HS/AHRQ HHS/United States
GR  - 1R18HS19154/HS/AHRQ HHS/United States
PT  - Journal Article
PT  - Research Support, U.S. Gov't, P.H.S.
PL  - United States
TA  - Ann Fam Med
JT  - Annals of family medicine
JID - 101167762
SB  - IM
MH  - Alaska
MH  - Comprehensive Health Care/organization & administration
MH  - Health Services Accessibility
MH  - Humans
MH  - Indians, North American
MH  - Inuit
MH  - *Outcome and Process Assessment, Health Care
MH  - Patient Care Team
MH  - Patient-Centered Care/*organization & administration
MH  - Primary Health Care/*organization & administration/statistics & numerical data
PMC - PMC3707246
OTO - NOTNLM
OT  - Alaska native
OT  - health disparities
OT  - mixed methods
OT  - patient-centered medical home
OT  - practice-based research
OT  - primary care
EDAT- 2013/05/25 06:00
MHDA- 2013/10/18 06:00
PMCR- 2013/11/01
CRDT- 2013/05/22 06:00
PHST- 2013/05/22 06:00 [entrez]
PHST- 2013/05/25 06:00 [pubmed]
PHST- 2013/10/18 06:00 [medline]
PHST- 2013/11/01 00:00 [pmc-release]
AID - 11/Suppl_1/S41 [pii]
AID - 0110s41 [pii]
AID - 10.1370/afm.1474 [doi]
PST - ppublish
SO  - Ann Fam Med. 2013 May-Jun;11 Suppl 1(Suppl 1):S41-9. doi: 10.1370/afm.1474.