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Practice Management Program
Primary Care Networks Program Management Office
Toward Optimized Practice

The Health Neighbourhood

What is the Health Neighbourhood?

The Health Neighbourhood includes the key services which together represent the health journey.  It includes the Patient's Medical Home and  other health and social care services such as specialists, hospitals, laboratory, emergency medical services, home care, continuing care.

The Alberta Medical Association is supporting PCNs to promote the Health Neighborhood as the context for the Patient's Medical Home; the family physician practice where an individual feels most comfortable discussing personal and/or family health concerns.  As part of our  contribution to the Primary Health Care Integration Network, we are facilitating inputs from physician leaders across the system and guiding the development of content and processes that will lead to improved transitions between the PMH and HN services.

What is Integration?

The AMA is a key partner in the Primary Health Care Integration Network which is one of the Strategic Clinical Networks within Alberta Health Services. You can find the Transformational Roadmap here.

Integration is about:

  • The continuum of care for patients

  • Building a strong primary healthcare system

  • System sustainability

  • Strengthening the health ecosystem

Aims of the Primary Health Care Integration Network:

  1. Find and share leading practices to achieve integration across Alberta

  2. Collaboratively seek solutions for current integration problems

  3. Accelerate spread and scale of initiatives in order to achieve significant system improvement

  4. Advance innovation to create the health neighbourhood.

 Areas of Focus for the Primary Healthcare Integration Network.

  1. Systems Foundations for Integration: Creating a strong foundation to be successful in the clinical areas

    • Person centered practices – building the system around what matters to patients, families and caregivers

    • Leadership and community mobilization- activating and supporting leaders and networks of practice to implement and spread/scale successful solutions

    • Science – using evidence to support system transformation

    • Communication and Learning – translating and sharing learnings across the system

  1. Keeping Care in the Community: Helping to ensure Albertans receive the personalized care and supports that will help them better manage their health in their own community, right where they live, work and play.

  2. Linking to Specialist and Back: Helping to close the gap between specialty care capacity and the needs and expectations of the public.

  3. Transitions from Home to Hospital to Home: As patients transition from their medical home or family doctor to the hospital and back to home again, there needs to be a transfer of support and information that transitions alongside them. Ensuring a person's primary care team is part of the care management and planning from admission to discharge is part of a system where patients are supported by effective hand-offs from one care provider to the next.