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J Gen Intern Med. 2012 Nov;27(11):1406-15. doi: 10.1007/s11606-012-2087-4. Epub 2012 Jun 1.

After-hours care and its coordination with primary care in the U.S.

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  • 1Center for Studying Health System Change, 1100 1st ST. SE 12th Floor, Washington, DC, 20002-4221, USA.



Despite expectations that medical homes provide "24 × 7 coverage" there is little to guide primary care practices in developing sustainable models for accessible and coordinated after-hours care.


To identify and describe models of after-hours care in the U.S. that are delivered in primary care sites or coordinated with a patient's usual primary care provider.


Qualitative analysis of data from in-depth telephone interviews.


Primary care practices in 16 states and the organizations they partner with to provide after-hours coverage.


Forty-four primary care physicians, practice managers, nurses and health plan representatives from 28 organizations.


Analyses examined after-hours care models, facilitators, barriers and lessons learned.


Based on 28 organizations interviewed, five broad models of after-hours care were identified, ranging in the extent to which they provide continuity and patient access. Key themes included: 1) The feasibility of a model varies for many reasons, including patient preferences and needs, the local health care market supply, and financial compensation; 2) A shared electronic health record and systematic notification procedures were extremely helpful in maintaining information continuity between providers; and 3) after-hours care is best implemented as part of a larger practice approach to access and continuity.


After-hours care coordinated with a patient's usual primary care provider is facilitated by consideration of patient demand, provider capacity, a shared electronic health record, systematic notification procedures and a broader practice approach to improving primary care access and continuity. Payer support is important to increasing patients' access to after-hours care.

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