Medical home implementation and trends in diabetes quality measures for AN/AI primary care patients

• Emergency visits decreased after PCMH implementation for DM-II patients.
• DM-II diagnoses increased after PCMH implementation.
• Positive trends in DM-II quality after PCMH implementation of varying strength.

AimsPatient-centered medical home (PCMH) principles including provider continuity, coordination of care, and advanced access align with healthcare needs of patients with Type II diabetes mellitus (DM-II). We investigate changes in trend for DM-II quality indicators after PCMH implementation at Southcentral Foundation, a tribal health organization in Alaska.MethodsMonthly rates of DM-II incidence, hemoglobin A1c (HbA1c) measurements, and service utilization were calculated from electronic health records from 1996 to 2009. We performed interrupted time series analysis to estimate changes in trend.ResultsRates of new DM-II diagnoses were stable prior to (p = 0.349) and increased after implementation (p < 0.001). DM-II rates of HbA1c screening increased, though not significantly, before (p = 0.058) and remained stable after implementation (p = 0.969). There was non-significant increasing trend in both periods for percent with average HbA1c less than 7% (53 mmol/mol; p = 0.154 and p = 0.687, respectively). Number of emergency visits increased before (p < 0.001) and decreased after implementation (p < 0.001). Number of inpatient days decreased in both periods, but not significantly (p = 0.058 and p = 0.101, respectively).ConclusionsWe found positive changes in DM-II quality trends following PCMH implementation of varying strength and onset of change, as well as duration of sustained trend.