• David L Driscoll, Vanessa Hiratsuka, Janet M Johnston, Sara Norman, Katie M Reilly, Jennifer Shaw, Julia Smith, Quenna N Szafran, and Denise Dillard.
• Institute for Circumpolar Health Studies, University of Alaska Anchorage, 3211 Providence Dr, DPL 404, Anchorage, AK 99508, USA. DavidDriscoll@uaa.alaska.edu
• Ann Fam Med. 2013 May 1; 11 Suppl 1 (Suppl 1): S41S49S41-9.

PurposeThis 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.MethodsWe 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.ResultsEmergency 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.ConclusionsAll 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.

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