title: Transitioning to Patient-Centered Medical Homes: Associations With Appointment Availability.
abstract: Recent implementation of the Patient-Centered Medical Home (PCMH) in military primary care has gained significant traction and attention from leadership and policy makers. The study objective was to measure the rate of change in appointment availability before and after primary care clinics were certified as a medical home. Access to care is one core tenet of the medical home and appointment availability is an important indicator of access.
  
  
  
  This was a retrospective, longitudinal observational study involving 21 U.S. Navy primary care clinics from 2011 to 2014. Appointment availability, as measured by third next available appointment, was constructed for 21 primary care clinics over a 29-month time period (14 months precertification, certification month, 14 months postcertification). A mixed-effects model with linear splines was applied where third next available appointment was the dependent variable. Main interest independent variables include time (precertification and postcertification). Remaining independent variables include categories pertaining to clinic characteristics, ancillary services, and nonemergent primary care treatable emergency department visits.
  
  
  
  Appointment availability improved slightly postcertification. Although there were statistically significant differences in appointment availability pre- and postcertification, the differences were so small that patients may not actually experience noticeable improvements.
  
  
  
  Although slight improvements in appointment availability following medical home certification exist, adoption of the medical home model in the military setting may not have all the potential outcomes expected on the basis of prior findings in civilian settings. This study demonstrated that improvements in appointment availability following medical home certification exist, but are quite small. Patients, as a result, are unlikely to notice any improvements. Additional research should test other expected benefits of PCMH in military settings. At that point, military policy makers can decide which aspects of PCMH practices merit sustaining.
authors.affiliation: Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814.
authors.forename: Todd C
authors.initials: TC
authors.lastname: Leroux
authors.affiliation: Department of Health Policy and Management, Texas A&M University School of Public Health, 1266 TAMU, College Station, TX 77843.
authors.forename: Murray J
authors.initials: MJ
authors.lastname: Côté
authors.affiliation: Department of Health Policy and Management, Texas A&M University School of Public Health, 1266 TAMU, College Station, TX 77843.
authors.forename: Hye-Chung
authors.initials: HC
authors.lastname: Kum
authors.affiliation: Department of Statistics, Texas A&M University, 3143 TAMU, College Station, TX 77843.
authors.forename: Alan
authors.initials: A
authors.lastname: Dabney
authors.affiliation: Department of Management, Policy, and Community Health, The University of Texas School of Public Health, 1200 Pressler Street, Houston, TX 77030.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Wells
mesh_terms: D001071:Appointments and Schedules; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008889:Military Personnel / Q000706:statistics & numerical data; D018802:Patient-Centered Care / Q000379:methods* / Q000458:organization & administration; D011320:Primary Health Care / Q000379:methods*; D012189:Retrospective Studies; D013997:Time Factors; D014481:United States