Calgary Zone Evolution, the benefits of integrated governance structures in primary care

The governance of Calgary Zone created and replicated several innovative programs that have enhanced primary care and its integration with other healthcare structures - acute, continuing, home and community. Calgary and area primary care networks refers to seven primary care networks operating within the Calgary Zone healthcare region in Alberta, Canada.Home to approximately .8 million residents, Calgary Zone covers urban and rural communities, and is part of the traditional territories of the Blackfoot Confederacy, the Tsuutina First Nation, the Stoney Nakoda, and the Mtis Nation of Alberta. The area is undergoing urbanization with 9% of the panelled patient population being based in Calgary, Airdrie, Okotoks, Cochrane, and Chestermere. The aging population is balanced with high numbers of intra-regional and international migrants, and a variety of temporary residents (students and work-permit holders). As a steadily growing population with an aging demographic, the Calgary Zone has created innovative solutions to address the range of needs across its population.The ability of Calgary Zone to develop, launch and scale these programs are largely due to its governance and operational frameworks, a structured collaboration that addresses financing, operational and programmatic alignment to meet shared goals. Governance levels in Calgary Zone include primary care, acute care, specialty care, community, patient and family advisors, indigenous partners, government partners, and other local and provincial representatives, as needed. Key to each approach was the co-creation of shared values and a vision that guides the collaborative capacity, and the formation of a dedicated zonal operational team in the form of single Zone Business Unit that streamlines communications, project management and evaluation structures for shared primary care services and reporting.Some of its successful programs have been: (i) designing a patient-provider portal to enable patient attachment to physicians; (ii) creating virtual solutions to facilitate real time interactions between primary and specialty care; (iii) developing processes to transition unattached patients more smoothly from hospitals; and (iv) launching a digital solution to address COVID-9 tracing during the pandemic that permitted the distribution of referrals from Alberta Health Services to Primary Care.RESULTS* The patient-provider portal to enable patient attachment to physicians was provincialized by Alberta Health and is now Alberta Find A Doctor* Virtual solutions to facilitate real time interactions between primary and specialty care has led to the provincialization of pathway development, and the expansion of specialty call services from 40 specialties to 52.* Developing processes to transition unattached patients more smoothly from hospitals (Enhanced Hospital Discharge) has emerged into a new pilot - After processing 8,000+ patient referrals and supporting more than 4,600 unattached patients with follow-up care between 207 - 2023, a new pilot will be tested to act as a centralized shared primary care resource to guide unattached medium-high risk patients post-hospital discharge.* Launched a digital solution to address COVID-9 tracing during the pandemic - Over 9,860 COVID positive cases managed by Calgary Zone PCNs between April 6 - July 29, 202.ImplicationsGovernance modeled around population trends are better able to create a shared purpose and vision that balances healthcare delivery requirements with patient needs in diverse populations.Dedicated operational resources empowered by governance structures are better equipped to guide the creation of standards for health care team engagement, to co-design and deliver more innovative, accessible, and efficient care, and to foster systems of engagement among technical partners that improves the quality of patient-health team relationships in rural, peri-urban, and urban communities. New methods of supporting patients and health care teams are being tested, including a patient navigator shared zonal service, the testing of pathway integration in electronic medical records (EMRs), and advocacy around more streamlined integration between primary care networks.

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