Journal of General Internal Medicine

, Volume 27, Issue 11, pp 1406–1415 | Cite as

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

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



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  coordination primary care 



This study was funded by The Commonwealth Fund (Grant #20100295).

The authors would also like to thank Dr. Robert Berenson, Dr. Ed Wagner and Dr. Stephen Schoenbaum for serving as external advisors to this project.

Conflict of Interest

The authors declare that they do not have a conflict of interest.

Supplementary material

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


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Copyright information

© Society of General Internal Medicine 2012

Authors and Affiliations

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

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