title: Tribal implementation of a patient-centred medical home model in Alaska accompanied by decreased hospital use.
abstract: BACKGROUND
  Between 1995 and 1998, tribally owned Southcentral Foundation (SCF) incrementally assumed responsibility from the Indian Health Service (IHS) for primary care services on the Alaska Native Medical Center (ANMC) campus in Anchorage, Alaska. In 1999, SCF began implementing components of a Patient-Centered Medical Home (PCMH) model to improve access and continuity of care.
  
  
  OBJECTIVE
  To evaluate hospitalisation trends before, during and after PCMH implementation.
  
  
  METHODS
  Time series analysis of aggregated medical record data.
  
  
  METHODS
  Regression analysis with correlated errors was used to estimate trends over time for the percent of customer-owners hospitalised overall and for specific conditions during 4 time periods (March 1996-July 1999: SCF assumes responsibility for primary care; August 1999-July 2000: PCMH implementation starts; August 2000-April 2005: early post-PCMH implementation; May 2005-December 2009: later post-PCMH implementation). Analysis was restricted to individuals residing in Southcentral Alaska and receiving health care at ANMC.
  
  
  RESULTS
  The percent of SCF customer-owners hospitalised per month for any reason was steady before and during PCMH implementation, declined steadily immediately following implementation and subsequently stabilised. The percent hospitalised per month for unintentional injury or poisoning also declined during and after the PCMH implementation. Among adult asthma patients, the percent hospitalised annually for asthma declined prior to and during implementation and remained lower thereafter. The percent of heart failure patients hospitalised annually for heart failure remained relatively constant throughout the study period while the percent of hypertension patients hospitalised for hypertension shifted higher between 1999 and 2002 compared to earlier and later years.
  
  
  CONCLUSIONS
  Implementation of PCMH at SCF was accompanied by decreases in the percent of customer-owners hospitalised monthly for any reason and for unintentional injury and in the percent of asthma patients hospitalised annually for asthma. Increased accessibility to empanelled care teams may have contributed to decreased need for hospitalisation.
authors.affiliation: Institute for Circumpolar Health Studies, University of Alaska Anchorage, Anchorage, AK 99508, USA. jmjohnston2@uaa.alaska.edu
authors.forename: Janet M
authors.initials: JM
authors.lastname: Johnston
authors.forename: Julia J
authors.initials: JJ
authors.lastname: Smith
authors.forename: Vanessa Y
authors.initials: VY
authors.lastname: Hiratsuka
authors.forename: Denise A
authors.initials: DA
authors.lastname: Dillard
authors.forename: Quenna N
authors.initials: QN
authors.lastname: Szafran
authors.forename: David L
authors.initials: DL
authors.lastname: Driscoll
mesh_terms: D000328:Adult; D000413:Alaska / Q000453:epidemiology; D001249:Asthma / Q000628:therapy; D006303:Health Services, Indigenous / Q000458:organization & administration*; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D007198:Indians, North American; D017146:Models, Organizational; D018802:Patient-Centered Care / Q000379:methods / Q000458:organization & administration*; D016730:Program Development
keywords: Alaska Native; Patient-Centered Medical Home; asthma; inpatient hospitalization; time series analysis