One goal of the Affordable Care Act is to improve patients' access to primary care and the coordination of that care. An important ingredient in achieving that goal is ensuring that patients have access to their primary care practice outside of regular business hours. This analysis of the 2010 Health Tracking Household Survey found that among people with a usual source of primary care, 40.2 percent reported that their practice offered extended hours, such as at night or on weekends. The analysis also found that one in five people who attempted after-hours contact with their primary care provider reported it was "very difficult" or "somewhat difficult" to reach a clinician. Those who reported less difficulty contacting a clinician after hours had significantly fewer emergency department visits (30.4 percent compared to 37.7 percent) and lower rates of unmet medical need (6.1 percent compared to 13.7 percent) than people who experienced more difficulty. The findings provide a valuable baseline on after-hours access, especially as patient-centered medical homes and accountable care organizations expand. Increasing support to primary care practices to offer or coordinate after-hours care may help reduce rates of emergency department use and unmet medical need.
"Some studies have, in fact, shown that single-handed GP practices are associated (albeit weakly) with greater utilization of hospital emergency rooms (Gulliford, Jack, Adams, & Ukoumunne, 2004). More recently, evaluations of the medical home model have suggested that well-functioning medical homes reduce the number of visits to the ER by child and adult patients (Cooley, McAllister, Sherrieb, & Kuhlthau, 2009; Gilfillan et al 2010; O'Malley, 2013; Reid et al. 2010; Roby et al., 2010). In our study, therefore , we hypothesize the following: "
[Show abstract][Hide abstract] ABSTRACT: Multiprofessional primary care models promise to deliver better care and reduce waste. This study evaluates the impact of such a model, the primary care unit (PCU), on three outcomes. A multilevel analysis within a "pre- and post-PCU" study design and a cross-sectional analysis were conducted on 215 PCUs located in the Emilia-Romagna region in Italy. Seven dimensions captured a set of processes and services characterizing a well-functioning PCU, or its degree of vitality. The impact of each dimension on outcomes was evaluated. The analyses show that certain dimensions of PCU vitality (i.e., the possibility for general practitioners to meet and share patients) can lead to better outcomes. However, dimensions related to the interaction and the joint works of general practitioners with other professionals tend not to have a significant or positive impact. This suggests that more effort needs to be invested to realize all the potential benefits of the PCU's multiprofessional approach to care.
Medical Care Research and Review 07/2014; 71(4):315-336. DOI:10.1177/1077558714536618 · 2.62 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: With US emergency care characterized as "at the breaking point," we studied how the aging of the US population would affect demand for emergency department (ED) services and hospitalizations in the coming decades. We applied current age-specific ED visit rates to the population structure anticipated by the Census Bureau to exist through 2050. Our results indicate that the aging of the population will not cause the number of ED visits to increase any more than would be expected from population growth. However, the data do predict increases in visit lengths and the likelihood of hospitalization. As a result, the aggregate amount of time patients spend in EDs nationwide will increase 10 percent faster than population growth. This means that ED capacity will have to increase by 10 percent, even without an increase in the number of visits. Hospital admissions from the ED will increase 23 percent faster than population growth, which will require hospitals to expand capacity faster than required by raw population growth alone.
Health Affairs 07/2013; 32(7):1306-12. DOI:10.1377/hlthaff.2012.0951 · 4.97 Impact Factor
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