American Indian and Alaska Native (AI/AN) people have age-adjusted death rates greater than the United States non-Hispanic White population for diabetes, alcoholism, suicide, and tuberculosis. Providing quality healthcare for this population is one means of reducing these disparities. Southcentral Foundation (SCF), a tribally-owned organization assumed management of primary care services in 1998 for AI/ANs in the Anchorage area after decades of management by the Indian Health Service. Based on feedback from patients, SCF implemented a patient-centered medical home (PCMH) model in 1999 and 2000. The SCF PCMH model has three key characteristics: patient-selected family match to a primary care team, patient-driven care, and advanced access. The SCF PCMH is viewed as a success within quality improvement circles but the impact of the PCMH transformation has not undergone rigorous scientific investigation. In this effort, University of Alaska Anchorage and SCF will partner to address the following specific aims:1) to determine the impact of the PCMH transformation on the characteristics and quality of patient care delivery and 2) to assess changes in healthcare delivery, such as quality and safety efforts, efforts to bring evidence to the point of care, use of information systems, and costs. Process measures will include patient- provider match and access. Health outcome measures will include percentage of newly diagnosed diabetics, diabetes with Hba1c levels <7%, and number of hospitalizations related to uncontrolled diabetes. Mixed methods will further assess patient and provider experiences and satisfaction, as well as steps taken to overcome challenges and achieve the PCMH transformation. To date, there have been no studies which examine the impact of a health system redesign among the AI/AN population. As the PCMH model affords itself to implementation in other primary care settings, this effort could have national implications for improving the health status of AI/AN people. Its urban focus is a strength given that the majority of the AI/AN populations reside in urban settings.

Public Health Relevance

Efforts to improve healthcare and reduce the costs associated with healthcare are a national priority. This effort addresses the effects of a patient-centered medical home model on quality, safety, efficiency, effectiveness and cost for an urban AI/AN population. The work proposed is relevant to other practices serving diverse populations with multiple health disparities.

National Institute of Health (NIH)
Agency for Healthcare Research and Quality (AHRQ)
Research Demonstration and Dissemination Projects (R18)
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Special Emphasis Panel (ZHS1-HSR-W (01))
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Meyers, David
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University of Alaska Anchorage
Schools of Public Health
United States
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Smith, Julia J; Johnston, Janet M; Hiratsuka, Vanessa Y et al. (2015) Medical home implementation and trends in diabetes quality measures for AN/AI primary care patients. Prim Care Diabetes 9:120-6
Smith, Julia J; Berman, Matthew D; Hiratsuka, Vanessa Y et al. (2015) The effect of regular primary care utilization on long-term glycemic and blood pressure control in adults with diabetes. J Am Board Fam Med 28:28-37
Johnston, Janet M; Smith, Julia J; Hiratsuka, Vanessa Y et al. (2013) Tribal implementation of a patient-centred medical home model in Alaska accompanied by decreased hospital use. Int J Circumpolar Health 72:
Driscoll, David L; Hiratsuka, Vanessa; Johnston, Janet M et al. (2013) Process and outcomes of patient-centered medical care with Alaska Native people at Southcentral Foundation. Ann Fam Med 11 Suppl 1:S41-9