Sarah L. Krein, PhD, RN

This study reports qualitative findings from an explanatory sequential mixed-methods investigation to understand hospitals’ approaches to a novel commercial episode-based reimbursement incentive program.

A metric of primary care delivery by non–primary care provider clinicians demonstrated increasing trends in patient encounters by nurses and social workers and was responsive to patient-centered medical home implementation.

Commonly used measures of performance for assessing patient access do not reflect PCMH-encouraged strategies to improve access that may be preferentially used by part-time physicians.

Additional training opportunities for primary care physicians and better use of ancillary services may be needed to further improve care for chronic pain patients.