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Home to Hospital to Home Transitions

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 are Home to Hospital to Home transitions?

One key transition of care patients experience occurs between the PMH and Hospital.  These are referred to as Home to Hospital to Home transitions H2H2H. 

The Primary Health Care Integration Network, along with primary care and community health service providers, specialists, patient and families have developed a H2H2H Transitions Guideline to identify best practices in facilitating effective H2H2H transitions of care.  

H2H2H Elements

H2H2H Transitions Guideline

Change Package and Tools

Training