title: Medical home implementation and trends in diabetes quality measures for AN/AI primary care patients.
abstract: OBJECTIVE
  Patient-centered medical home (PCMH) principles including provider continuity, coordination of care, and advanced access align with healthcare needs of patients with Type II diabetes mellitus (DM-II). We investigate changes in trend for DM-II quality indicators after PCMH implementation at Southcentral Foundation, a tribal health organization in Alaska.
  
  
  METHODS
  Monthly rates of DM-II incidence, hemoglobin A1c (HbA1c) measurements, and service utilization were calculated from electronic health records from 1996 to 2009. We performed interrupted time series analysis to estimate changes in trend.
  
  
  RESULTS
  Rates of new DM-II diagnoses were stable prior to (p=0.349) and increased after implementation (p<0.001). DM-II rates of HbA1c screening increased, though not significantly, before (p=0.058) and remained stable after implementation (p=0.969). There was non-significant increasing trend in both periods for percent with average HbA1c less than 7% (53 mmol/mol; p=0.154 and p=0.687, respectively). Number of emergency visits increased before (p<0.001) and decreased after implementation (p<0.001). Number of inpatient days decreased in both periods, but not significantly (p=0.058 and p=0.101, respectively).
  
  
  CONCLUSIONS
  We found positive changes in DM-II quality trends following PCMH implementation of varying strength and onset of change, as well as duration of sustained trend.
authors.affiliation: Southcentral Foundation Research Department, 4105 Tudor Centre Drive, Suite 200, Anchorage, AK 99508, USA. Electronic address: jsmith@scf.cc.
authors.forename: Julia J
authors.initials: JJ
authors.lastname: Smith
authors.affiliation: Institute for Circumpolar Health Studies, University of Alaska Anchorage, 3211 Providence Drive DPL 404, Anchorage, AK 99508, USA.
authors.forename: Janet M
authors.initials: JM
authors.lastname: Johnston
authors.affiliation: Southcentral Foundation Research Department, 4105 Tudor Centre Drive, Suite 200, Anchorage, AK 99508, USA.
authors.forename: Vanessa Y
authors.initials: VY
authors.lastname: Hiratsuka
authors.affiliation: Southcentral Foundation Research Department, 4105 Tudor Centre Drive, Suite 200, Anchorage, AK 99508, USA.
authors.forename: Denise A
authors.initials: DA
authors.lastname: Dillard
authors.affiliation: Southcentral Foundation Research Department, 4105 Tudor Centre Drive, Suite 200, Anchorage, AK 99508, USA.
authors.forename: Steve
authors.initials: S
authors.lastname: Tierney
authors.affiliation: Institute for Circumpolar Health Studies, University of Alaska Anchorage, 3211 Providence Drive DPL 404, Anchorage, AK 99508, USA.
authors.forename: David L
authors.initials: DL
authors.lastname: Driscoll
mesh_terms: D000413:Alaska / Q000453:epidemiology; D015415:Biomarkers / Q000097:blood; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000175:diagnosis / Q000208:ethnology / Q000628:therapy*; D004636:Emergency Service, Hospital / Q000639:trends; D006442:Glycated Hemoglobin / Q000378:metabolism; D006295:Health Resources / Q000592:standards / Q000639:trends*; D006801:Humans; D015994:Incidence; D007198:Indians, North American; D007902:Length of Stay / Q000639:trends; D010343:Patient Admission / Q000639:trends; D018802:Patient-Centered Care / Q000592:standards / Q000639:trends*; D011237:Predictive Value of Tests; D011320:Primary Health Care / Q000592:standards / Q000639:trends*; D015397:Program Evaluation; D058996:Quality Improvement / Q000592:standards / Q000639:trends*; D019984:Quality Indicators, Health Care / Q000592:standards / Q000639:trends*; D013997:Time Factors; D014481:United States; D016549:United States Indian Health Service / Q000592:standards / Q000639:trends*
chemical_list: D015415:Biomarkers; D006442:Glycated Hemoglobin; C517652:hemoglobin A1c protein, human
keywords: Diabetes; Native American; Patient-centered medical home; Primary care