Journal of General Internal Medicine

, Volume 27, Issue 11, pp 1406–1415

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

  • Ann S. O’Malley
  • Divya Samuel
  • Amelia M. Bond
  • Emily Carrier
Original Research

DOI: 10.1007/s11606-012-2087-4

Cite this article as:
O’Malley, A.S., Samuel, D., Bond, A.M. et al. J GEN INTERN MED (2012) 27: 1406. doi:10.1007/s11606-012-2087-4



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.


after-hours care coordinationprimary care

Supplementary material

11606_2012_2087_MOESM1_ESM.doc (48 kb)
ESM 1(DOC 48 kb)

Copyright information

© Society of General Internal Medicine 2012

Authors and Affiliations

  • Ann S. O’Malley
    • 1
  • Divya Samuel
    • 1
  • Amelia M. Bond
    • 1
  • Emily Carrier
    • 1
  1. 1.Center for Studying Health System ChangeWashingtonUSA