264097 Assessing changes in healthcare access, experiences, ER use, hospitalizations, and outcomes before and after implementation of a patient-centered medical home in Alaska

Tuesday, October 30, 2012 : 2:50 PM - 3:10 PM

David Driscoll, PhD, MPH , Institute for Circumpolar Health Studies, University of Alaska, Anchorage, Anchorage, AK
     
Background: Southcentral Foundation (SCF), which provides healthcare to Alaska Native and American Indian people in southcentral Alaska, implemented a new model of primary care in 2000 that included the following components of a patient-centered medical home (PCMH): integrated care teams, patient-provider empanelment and same-day appointments. This study assesses changes in healthcare delivery, utilization and outcomes before, during and after implementation. Methods: In this mixed-methods evaluation, outcome and utilization trends were assessed by extracting aggregate monthly counts of emergency care (EC) visits and inpatient hospitalizations. Healthcare delivery changes were assessed by in-depth interviews with patients, staff, tribal leaders, and healthcare providers. Results: EC visits for all patients and for diabetics were increasing before implementation of the new model of care, then decreased quickly during implementation and subsequently continued to decrease more slowly before eventually leveling off. Inpatient hospitalizations were steady before and during implementation, declined immediately after, and subsequently stabilized. Interview participants described improved healthcare quality and access after implementation. Improved access was linked to evolving increases in staffing, changes in staff responsibilities, and improved culturally-competent patient-provider communication. Increased healthcare access generated benefits and challenges. Increased staffing, enhanced healthcare facility design, and improved communications helped to alleviate challenges. Conclusion: PCMH implementation was accompanied by declining EC and hospitalization rates for all patients, including those with serious chronic conditions. Increased patient access improved patient and provider experiences. Health improvements in a population with a multitude of health disparities were achieved as the health system overcame manageable challenges.

Learning Areas:
Chronic disease management and prevention
Conduct evaluation related to programs, research, and other areas of practice
Public health or related research

Learning Objectives:
1. Assess changes in healthcare delivery, utilization and outcomes during and after the implementation of a primary care patient-centered medical home (PCMH) model of healthcare within an Alaska Native and American Indian population. 2. Describe changes in patient, staff, tribal leader and healthcare provider experiences within the healthcare system during and after the implementation of a PCMH model of healthcare. 3. Discuss the benefits and challenges of implementing a PCMH model of healthcare and describe how challenges were overcome.

Keywords: Alaska Natives, Medical Care

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: Dr. Driscoll is the primary investigator of this evaluation, overseeing all areas of the project, and is therefore qualified to be an abstract author.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

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