The following menu summarizes anticipated key values and benefits from the perspective of identified stakeholder groups based on the work of the PHC Integration Network.
Community-based healthcare and social services are available when needed and more coordinated, resulting in less need for emergency department and hospital visits.
Better coordinated, faster access to specialist care when needed.
More proactive and coordinated follow-up care when leaving hospital.
Patients, families, caregivers and community members will be actively engaged with care providers and other partners to co-create innovative solutions for care coordination challenges.
PCNs, primary care physicians and their teams
More timely care for patients, including improved access to specialist care for advice and patient referrals, better continuity at key transition points such as discharge from hospital and better coordination with community resources.
Improved ability to participate in care planning for patients who are being seen in other parts of the health system.
More comprehensive and timely information about patients who are transitioning from acute care into the community, resulting in better continuity of care.
Opportunities to provide leadership in provincial initiatives that improve care coordination and advance other aspects of health system transformation in alignment with PCN Evolution plans.
Support to implement and use care pathways, guidelines and other tools that enable better care for patients.
Coordinated supports (including quality improvement, measurement and evaluation, and SCN resources) that enable partnerships with other providers in the community.
Opportunities to learn from successes in other parts of the province; to access and implement innovation developed within SCNs; and incorporate supports and services provided by AHS zones and provincial programs.
Alberta Health Services
Improved patient care, better outcomes and optimized use of resources resulting from more appropriate use of emergency department and acute care resources.
Greater coordination of quality improvement and other support resources and services that are currently distributed across zones and provincial programs.
Better information about the impact of care coordination initiatives, resulting in greater accountability and ability to direct resources toward effective community-based models of care.
Improved return on investment from provincial initiatives that require active participation by PHC partners and joint leadership.
Opportunity to test innovative models of care coordination that look at shifting care to the community and strengthening the primary healthcare system.
Government of Alberta
Better information about integration challenges and successes to support development of provincial policies and directions.
Evidence of actions that directly align with Ministry strategic directions.
Stronger accountability from AHS, PCNs and other health system partners due to more comprehensive performance reporting related to integration.
Evidence that integrated models of care are resulting in more appropriate use of health system resources.
Strategic Clinical Networks
Improved access to family physicians, other Primary Health Care leaders and PCNs to support SCN priorities.
Resources to facilitate design, implementation and spread of innovative integration solutions that require PHC involvement.
Greater impact on health system performance as a result of better engagement with PHC stakeholders in individual and pan-SCN priorities, and better uptake of solutions.
Improved information about PCN operational priorities, resulting in better alignment of priorities between policy-makers, providers and researchers and utilization of research findings.
Support to develop research partnerships.
Opportunity for advancing knowledge development, knowledge translation and academic capacity in the primary healthcare research community.
Specialist physicians and teams
Ensure effective and appropriate referrals are received in an efficient way.
Support to partner with AHS zones, primary care and other community partners to develop and implement pathways.
Improved access to care pathways, guidelines and other tools that enable better care for patients.
Improved communication and partnerships between healthcare providers across the health system.
Improved ability to work with healthcare partners to ensure shared clients are supported in a coordinated way.