Lessons in Linking After-Hours Care to Primary Care

Journal of General Internal Medicine Study Explores How Primary Care Practices Can Provide Care Outside Normal Business Hours

Media Advisory
June 4, 2012

Alwyn Cassil (202) 264-3484 or acassil@hschange.org

WASHINGTON, DC—From solo physicians sharing on-call coverage to large practices contracting with urgent care centers, financial backing from payers and electronic health records (EHRs) can help support coordination of after-hours care with patients’ primary care practices, according to a study by the Center for Studying Health System Change (HSC) published online in The Journal of General Internal Medicine (JGIM).

The study also found that efforts to provide after-hours care often work best when adopted as part of a broader primary care practice strategy to improve access and continuity of patient care. About two-thirds of all U.S. emergency department visits occur between 5 p.m. and 8 a.m. or on weekends, and a substantial portion of those visits likely could be managed in less-costly settings if appropriate after-hours care were available.

Yet, there is little to guide primary care physicians (PCPs) in developing sustainable models of after-hours care, according to the JGIM study, which was supported by the Commonwealth Fund and based on in-depth interviews with 44 primary care physicians, practice managers, nurses and health plan representatives from 28 organizations involved with providing after-hours care.

“Three key themes were common to current models that coordinate after-hours care with a patient’s usual PCP: After-hours care systems must incorporate feasible and sustainable designs that meet local population needs; a shared EHR and systematic notification procedures between the after-hours provider and daytime PCP are extremely helpful; and 24x7 access is best implemented as part of a larger practice approach to access and continuity,” according to the article by HSC Senior Researcher Ann S. O’Malley, M.D., M.P.H.; Divya Samuel, an HSC research assistant; Amelia M. Bond, M.H.S., an HSC research analyst; and HSC Senior Researcher Emily Carrier, M.D., M.S.C.I.

The study, titled “After-Hours Care and its Coordination with Primary Care in the U.S.,” identified five models of after-hours care coordinated with primary care: same PCP all the time; PCP plus practice partners, usually with limited extended hours and 24-7 phone coverage; PCP plus small, local cross-coverage network, usually 24-7 phone coverage and sometimes extended hours; PCP plus large cross-coverage network that may have multiple sites with extended hours and may own an urgent care center or after-hours clinic; and PCP contracting with an urgent care center or after-hours clinic.

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The Center for Studying Health System Change is a nonpartisan policy research organization committed to providing objective and timely research on the nation’s changing health system to help inform policy makers and contribute to better health care policy. HSC, based in Washington, D.C., is affiliated with Mathematica Policy Research.