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Research ArticleOriginal Articles

Process and Outcomes of Patient-Centered Medical Care With Alaska Native People at Southcentral Foundation

David L. Driscoll, Vanessa Hiratsuka, Janet M. Johnston, Sara Norman, Katie M. Reilly, Jennifer Shaw, Julia Smith, Quenna N. Szafran and Denise Dillard
The Annals of Family Medicine May 2013, 11 (Suppl 1) S41-S49; DOI: https://doi.org/10.1370/afm.1474
David L. Driscoll
1University of Alaska, Anchorage, Alaska
PhD, MPH, MA
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  • For correspondence: DavidDriscoll@uaa.alaska.edu
Vanessa Hiratsuka
2Southcentral Foundation, Anchorage, Alaska
MPH
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Janet M. Johnston
1University of Alaska, Anchorage, Alaska
PhD
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Sara Norman
2Southcentral Foundation, Anchorage, Alaska
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Katie M. Reilly
1University of Alaska, Anchorage, Alaska
MPH
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Jennifer Shaw
2Southcentral Foundation, Anchorage, Alaska
MA
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Julia Smith
2Southcentral Foundation, Anchorage, Alaska
MS
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Quenna N. Szafran
1University of Alaska, Anchorage, Alaska
BS, RN
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Denise Dillard
2Southcentral Foundation, Anchorage, Alaska
PhD
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Abstract

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.

  • patient-centered medical home
  • mixed methods
  • health disparities
  • Alaska native
  • primary care
  • practice-based research
  • Received for publication June 29, 2012.
  • Revision received November 9, 2012.
  • Accepted for publication November 19, 2012.
  • © 2013 Annals of Family Medicine, Inc.
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The Annals of Family Medicine: 11 (Suppl 1)
The Annals of Family Medicine: 11 (Suppl 1)
Vol. 11, Issue Suppl 1
May/June 2013
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Process and Outcomes of Patient-Centered Medical Care With Alaska Native People at Southcentral Foundation
David L. Driscoll, Vanessa Hiratsuka, Janet M. Johnston, Sara Norman, Katie M. Reilly, Jennifer Shaw, Julia Smith, Quenna N. Szafran, Denise Dillard
The Annals of Family Medicine May 2013, 11 (Suppl 1) S41-S49; DOI: 10.1370/afm.1474

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Process and Outcomes of Patient-Centered Medical Care With Alaska Native People at Southcentral Foundation
David L. Driscoll, Vanessa Hiratsuka, Janet M. Johnston, Sara Norman, Katie M. Reilly, Jennifer Shaw, Julia Smith, Quenna N. Szafran, Denise Dillard
The Annals of Family Medicine May 2013, 11 (Suppl 1) S41-S49; DOI: 10.1370/afm.1474
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