title: Process and outcomes of patient-centered medical care with Alaska Native people at Southcentral Foundation.
abstract: OBJECTIVE
  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.
authors.affiliation: Institute for Circumpolar Health Studies, University of Alaska Anchorage, 3211 Providence Dr, DPL 404, Anchorage, AK 99508, USA. DavidDriscoll@uaa.alaska.edu
authors.forename: David L
authors.initials: DL
authors.lastname: Driscoll
authors.forename: Vanessa
authors.initials: V
authors.lastname: Hiratsuka
authors.forename: Janet M
authors.initials: JM
authors.lastname: Johnston
authors.forename: Sara
authors.initials: S
authors.lastname: Norman
authors.forename: Katie M
authors.initials: KM
authors.lastname: Reilly
authors.forename: Jennifer
authors.initials: J
authors.lastname: Shaw
authors.forename: Julia
authors.initials: J
authors.lastname: Smith
authors.forename: Quenna N
authors.initials: QN
authors.lastname: Szafran
authors.forename: Denise
authors.initials: D
authors.lastname: Dillard
mesh_terms: D000413:Alaska; D003191:Comprehensive Health Care / Q000458:organization & administration; D006297:Health Services Accessibility; D006801:Humans; D007198:Indians, North American; D004930:Inuit; D010043:Outcome and Process Assessment, Health Care; D010348:Patient Care Team; D018802:Patient-Centered Care / Q000458:organization & administration*; D011320:Primary Health Care / Q000458:organization & administration* / Q000706:statistics & numerical data
keywords: Alaska native; health disparities; mixed methods; patient-centered medical home; practice-based research; primary care