After-Hours Care and Its Coordination with Primary Care in the U.S.

Synopsis

A Commonwealth Fund–supported analysis of primary care practices that provide after-hours care to patients found that success in delivering this medical home service was closely linked to physician buy-in; effective communication bolstered by electronic health records (EHRs); adjustments to scheduling and staffing capacity, including the use of nurse triage phone lines; and an overall commitment to improving access and continuity in patient–provider relationships. Going forward, payer support will be important to increasing patients’ access to after-hours care.

The Issue

Research shows that continuity in primary care, including care received outside usual business hours, is associated with improved patient outcomes and lower emergency department (ED) use. However, fewer than 30 percent of physicians say their practice has arrangements for ensuring after-hours care for patients, other than automated phone referral to the emergency department. Medical homes are expected to provide 24/7 coverage, but there is little to guide primary care practices in developing sustainable models for accessible and coordinated after-hours care. To identify promising after-hours care models, the Center for Studying Health System Change interviewed practices and organizations that provide such care.

Key Findings

Interviews identified five different models that practices use to provide after-hours care coordinated with primary care:

• Work in small practices (solo or two-person) where a physician is available around-the-clock.
• Form partnerships with other practices, so that physicians can rotate after-hours shifts.
• Join a small, local cross-coverage network; for example, in the Adirondack Regional Medical Home Pilot, providers cover each other’s patient panels.
• Join a large cross-coverage network, such as the Geisinger Health System in Pennsylvania, which has staffed after-hours clinics and urgent care centers.
• Enter a contractual relationship with an urgent care center or after-hours clinic.