• Dylan H Roby, Nadereh Pourat, Matthew J Pirritano, Shelley M Vrungos, Himmet Dajee, Dan Castillo, and Gerald F Kominski.
• University of California-Los Angeles, UCLA School of Public Health, Department of Health Services & Center for Health Policy Research, 10960 Wilshire Blvd, Suite 1550, Los Angeles, CA 90024, USA. droby@ucla.edu
• Med Care Res Rev. 2010 Aug 1;67(4):412-30.

AbstractThe Medical Services Initiative program--a safety net-based system of care--in Orange County included assignment of uninsured, low-income residents to a patient-centered medical home. The medical home provided case management, a team-based approach for treating disease, and increased access to primary and specialty care among other elements of a patient-centered medical home. Providers were paid an enhanced fee and pay-for-performance incentives to ensure delivery of comprehensive treatment. Medical Services Initiative enrollees who were assigned to a medical home for longer time periods were less likely to have any emergency room (ER) visits or multiple ER visits. Switching medical homes three or more times was associated with enrollees being more likely to have any ER visits or multiple ER visits. The findings provide evidence that successful implementation of the patient-centered medical home model in a county-based safety net system is possible and can reduce unnecessary ER use.

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