primary care diabetes 9 ( 2 0 1 5 ) 120–126 Contents lists available at ScienceDirect Primary Care Diabetes journal homepage: http://www.elsevier.com/locate/pcd Original research Medical home implementation and trends in diabetes quality measures for AN/AI primary care patients Julia J. Smith a,* , Janet M. Johnston b , Vanessa Y. Hiratsuka a , Denise A. Dillard a , Steve Tierney a , David L. Driscoll b a Southcentral Foundation Research Department, 4105 Tudor Centre Drive, Suite 200, Anchorage, AK 99508, USA b Institute for Circumpolar Health Studies, University of Alaska Anchorage, 3211 Providence Drive DPL 404, Anchorage, AK 99508, USA article info Article history: Received 12 November 2013 Received in revised form 16 June 2014 Accepted 30 June 2014 Available online 2 August 2014 Keywords: Patient-centered medical home Native American Primary care Diabetes abstract Aims: Patient-centered medical home (PCMH) principles including provider continuity, coor- dination 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. Methods: Monthly 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. Results: Rates 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 signifi- cantly, 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). Conclusions: We found positive changes in DM-II quality trends following PCMH implemen- tation of varying strength and onset of change, as well as duration of sustained trend. © 2014 Primary Care Diabetes Europe. Published by Elsevier Ltd. All rights reserved. 1. Introduction Quality health care including regular preventive care (e.g. regu- lar hemoglobin A1c [HbA1c] screening) can foster early disease ∗ Corresponding author at: Southcentral Foundation Research Department, 4105 Tudor Centre Drive, Suite 200, Anchorage, AK 99508 USA. Tel.: +1 907 729 4281; fax: +1 907 729 5464. E-mail address: jsmith@scf.cc (J.J. Smith). identification and make the difference between maintaining quality of life or experiencing debilitating or even life-ending complications among people with Type II diabetes mellitus (DM-II) [1]. Self-management is also critical for positive health outcomes; thus healthcare providers can greatly improve http://dx.doi.org/10.1016/j.pcd.2014.06.005 1751-9918/© 2014 Primary Care Diabetes Europe. Published by Elsevier Ltd. All rights reserved.