Providing Insights that Contribute to Better Health Policy
Insurance Coverage & Costs Access to Care Quality & Care Delivery Health Care Markets Issue Briefs Data Bulletins Research Briefs Policy Analyses Community Reports Journal Articles Other Publications Surveys Site Visits Design and Methods Data Files
After-Hours Care and its Coordination with Primary Care in the U.S.
June 4, 2012
Background: Despite expectations that medical homes provide "24 x 7 coverage" there is little to guide primary care practices in developing sustainable models for accessible and coordinated after-hours care.
Objective: To identify and describe models of afterhours care in the U.S. that are delivered in primary care sites or coordinated with a patients usual primary care provider.
Design: Qualitative analysis of data from in-depth telephone interviews.
Setting: Primary care practices in 16 states and the organizations they partner with to provide after-hours coverage.
Participants: Forty-four primary care physicians, practice managers, nurses and health plan representatives from 28 organizations.
Approach: Analyses examined after-hours care models, facilitators, barriers and lessons learned.
Results: Based on 28 organizations interviewed, five broad models of after-hours care were identified, ranging in the extent to which they provide continuity and patient access. Key themes included: 1) The feasibility of a model varies for many reasons, including patient preferences and needs, the local health care market supply and financial compensation; 2) A shared electronic health record and systematic notification procedures were extremely helpful in maintaining information continuity between providers; and 3) after-hours care is best implemented as part of a larger practice approach to access and continuity.
Conclusion: After-hours care coordinated with a patients usual primary care provider is facilitated by consideration of patient demand, provider capacity, a shared electronic health record, systematic notification procedures and a broader practice approach to improving primary care access and continuity. Payer support is important to increasing patientsâ€™ access to after-hours care.
Access to this article is available at the Journal of General Internal Medicine Web site. (Subscription required.)