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Integration: AHS Publishes Case Studies and Expert Advice

Article Abstracts

Read the full 2009 Special Issue Health Care Quarterly Vol. 13 publication.

Introduction to Integration

All Together Now: A Conceptual Exploration of Integrated Care
Author: Dennis Kodner

The need for health system integration to meet changing patient needs and community expectations is widely recognized. This article explores the many definitions, concepts, logics and methods found in health-system and service integration, summarizes the main building blocks of integrated care and suggests a way to address its various complexities and unknowns in a real-world sense.

Ten Key Principles for Successful Health Systems Integration
Authors: Esther Suter, Nelly D. Oelke, Carol E. Adair and Gail D. Armitage

Despite the growing enthusiasm for integration, information about implementing and evaluating integration-related initiatives is not easily accessible. In a systematic literature review of health services and business articles, the authors discovered 10 principles that were frequently and consistently presented as key elements for successful integration.

Invited Papers

Integrated Care Needs Integrated Information Management and Technology
Author: Denis Protti
 A key issue in supporting cooperation and collaboration required in today’s healthcare systems is the need for information sharing between different care providers. This paper discusses models for integration and different levels of interoperability to be considered in the goal of achieving a seamless and secure information transfer between different information systems.

Integrated Health Systems and Integrated Knowledge: Creating Space for Putting Knowledge into Action
Authors: Cathie Scott, Judy Seidel, Sarah Bowen and Nadine Gall

The capacity to innovate and share knowledge is not well developed within health systems, and few resources are dedicated to these important activities. In this paper, the authors draw from current evidence to illustrate a range of principles and strategies for creating knowledge-rich healthcare environments – for integrating knowledge use into practice.

Process Improvement and Supply and Demand: The Elements That Underlie Integration
Author: Mark Murray

Successful integration requires linking four key strategies: people-centred care, eduction of variation, a focus on the care continuum and improvement in process management. An underlying dynamic of integration dictates that system capacity must match demand, or delays will increase and the system will fail.

Making Integration Work Requires More than Goodwill
Author: Linda Smyth

Healthcare organizations can no longer operate in isolation. Care paths and integration of health services that cross organizations, jurisdictions, geographical boundaries, and public and private providers require collaborative relationships. Governance emerges as a key determinant of project progress, and successful integration of health services requires integrated governance.

Engaging the Head and Heart: Leading Change
Author: Jack Silversin

“The organizations I work with are beginning to understand that the key to successful change is engaging people at all levels of the organization. The days of top-down, command and control change management are gone. Imposing change on people leads to resistance, lack of commitment, even sabotage. You lead change; people manage themselves.” ― Q&A with Jack Silversin

Case Studies

Health Link Alberta: A Model for Successful Health Service Integration
Author: Shaunne Letourneau

Health Link Alberta (HLA) is a health advice and information service available to all Albertans, 24/7, through telephone and Internet. Launched as a single-region service in 2000, HLA was rolled out province-wide in 2003. Within three years, it had achieved 63% awareness and 46% utilization among all households.

Improving Patient Access to Medical Services: Preventing the Patient from Being Lost in Translation
Authors: Allison Bichel, Shannon Erfle, Valerie Wiebe, Dick Axelrod and John Conly

The Medical Access to Service project adopted a central access and triage (CAT) model and a standardized patient referral form to improve patient access to specialties. Waits are now based on patient urgency rather than physician name. Reductions in wait times have been dramatic.

Enhancing Patient Care via a Pharmacist-Managed Rural Anticoagulation Clinic
Authors: Cindy Jones and Guy Lacombe

Establishing integrated anticoagulation management services in satellite clinics in Alberta is improving outcomes for patients on anticoagulation therapy. Patients are stabilized sooner, with few blood draws, benefiting not only the patient but the healthcare system as a whole. The experience of the Athabasca AMS clinic and its patients is presented in this article.

Organizing Care across the Continuum: Primary Care, Specialty Services, Acute and Long-term Care
Authors: Nelly Oelke, Leslie Cunning, Kaye Andrews, Dorothy Martin, Anne MacKay, Katie Kuschminder and Val Congdon

The Calgary Rural Primary Care Network has implemented a community-based model where physicians and Alberta Health Services work together to deliver primary care that addresses the needs of local populations. Patients, providers and the healthcare system are realizing early positive outcomes, and patients are receiving services locally that were previously unavailable or would have required travel to Calgary.

Integrated Stroke Care across a Province – Is It Possible?
Authors: Agnes Joyce and Shy Amlani

The former Central Health region’s integrated stroke services encompass central and northern Alberta communities, where CH has supported the creation of numerous Primary Stroke Centres. Through her local PCS, the rural patient in this case study was promptly assessed and treated via Telehealth, minimizing the disabling effects of stroke and preserving her quality of life.

The Alberta Cardiac Access Collaborative: Improving the Cardiac Patient Journey
Authors: Robyn Blackadar and Mishaela Houle

The Alberta Cardiac Access Collaborative (ACAC) is a joint initiative of Alberta’s health system to improve access to adult cardiac services across the patient journey. ACAC has created new care delivery models and implemented best practices across Alberta in four streams across the continuum: heart attack, patient navigation, heart failure and arrhythmia.

Implementation and Evaluation of a Community-Based Medication Reconciliation (CMR) System at the Hospital–Community Interface of Care
Authors: Allan L. Bailey, Grace Moe, Jessica Moe, Ryan Oland, Keith McNicol, Gregory Boughen and Stanley Kroeker

The WestView community-based medication reconciliation aims to decrease the risk of medication errors. Within 72 hours of a patient’s discharge from hospital, a pharmacist visits the home and reconciles all the patient’s medications. The program is too new for results to be presented, but a concurrent study is measuring patient safety and the incidence of drug-related adverse events.

Alberta’s Systems Approach to Chronic Disease Management and Prevention Utilizing the Expanded Chronic Care Model
Authors: Sandra Delon and Blair MacKinnon on behalf of the Alberta Health CDM Advisory Committee

Alberta’s chronic disease management programs are now well established and seeing gratifying results. In a one-year follow-up, diabetes and dyslipidemia patients are improving control over their disease, inpatient admissions have decreased 41% and ER visits, 34%. The key lessons learned have been to clearly identify program admission criteria and the roles and responsibilities.

Read the full 2009 Special Issue Health Care Quarterly Vol. 13 publication.