Article Figures & Data
Figures
- Figure 1.
Primary care organization in Alberta.
PCN = primary care network.
Tables
Study Population Numbers of Participants Alberta Health Services – public health 1 Alberta Health Services – primary care 5 • Leadership, administration, data management Calgary Zone Primary Care Network 36 • Administration, clinical leadership, data management Independent clinicians affiliated with PCNs 10 AHS-run clinics (C4 clinic) 3 • Administration, clinicians and data management AHS = Alberta Health Services; C4 = Calgary COVID-19 Care Clinic; PCN = primary care network.
Quote Number Participant Number Text Results: Building the data bridge 1 037 Originally, the AHS public health officer in Calgary got the laboratory results. Then they handed them on to an AHS primary care facility in the zone designated for COVID-19 primary care. This facility would get these lists of patients who had tested positive and sort them by postal code. The AHS staff actually did this manually!
The PCNs learned about this and said, “We will take as many of the patients that are on those lists as possible” because we knew that most positive patients would have a mild experience, so they would need monitoring at home and help in managing their isolation requirements...
Then in the summer of 2020 a Data Hub managed by an IT professional based in one of the PCNs was developed...and in September the Hub went live. The Hub sorted positive test results in an automated way and sent the patient referral lists, based on the patient’s postal code, to 1 of the 4 PCN Access Clinics.
At those Access Clinics, when a patient list was received, PCN staff would go into the provincial medical data portal to see if that patient had a family physician. If the patient did, the Access Clinics would notify their doctor that they had tested positive, hoping that the doctor would follow-up. If the patient did not have a family doctor, dedicated Access Clinic physicians would follow-up.2 034 COVID has shown us that there was a significant lack of integration between systems still. In particular, information continuity [and the] notification of doctors of test [results]. It has also made it clear that...it isn’t that hard to do, we just need to do it. We know we need better integration, and we have done it here well. Results: Integration mechanisms - relationships 3 037 It has been [a] long established relationship, [at least 13 years,] between AHS and the PCNs and within PCNs. This meant there was a level of trust. It also increased the opportunities [to identify] possible opportunities for better integration. We had already succeeded in partnering [on other projects]. 4 007 The existing work before the COVID pandemic in the Calgary Zone had already created trust. The existing relationships were used to respond to COVID. 5 001 Well, sure you can tell [the patients] that they’ve got COVID. And you can tell them that they shouldn’t go out anywhere. But who will manage their health care? Who will from day to day make sure that these people aren’t decompensating?
That seemed to be a blind spot for public health except for [the public health officer] who became a real advocate for us. When we said that family physicians needed to know directly that their patients have COVID to facilitate transfer of care and follow up...it was [the public health officer] really advocating for [the data to be shared].6 007 …[the public health officer] really focused their efforts on communicating and developing relationships within the Calgary Zone. That’s not something we’ve had in the past actually. The [public health] system is provincial, whereas almost all of our service delivery...is zonal. So there’s always a funny disconnect there. [The officer] came on a couple of years ago and he changed the focus to be very Calgary-active. That was a huge piece of creating a connection between what was happening in public health with what was happening in primary care and championing the importance of primary care. Results: Integration mechanisms – organizational structures 7 017 [Before COVID] I did a fair amount of work with hospital discharges and admissions...So that was my first kind of major introduction to working with AHS. And that’s why working with the COVID [test results data] was really easy for me. I had already learned the processes and built the software algorithms to basically absorb [AHS] data, figure out [which primary care doctor] the patient belonged to if they did [belong to anyone], and then to notify the right people. So when COVID came in and [there was a rush] to figure out the data and where it needed to go, because of the hospital discharge work, I could right away see “Oh this is pretty straightforward if we send the patients to the appropriate PCN [or Access Clinic].” Results: Integration mechanisms – governance arrangements 8 001 First, the governance [of the Calgary Zone] is key. They can make decisions. Whether it’s financial decisions or decisions about how the 7 PCNs work together. For example: the Access Clinics; the data hub; things like that. [The PCNs] also have a role...in education, [and] communication [with their physician members]. [That role] has been an...important piece of this whole response. PCNs were conduits of consistent regular communication to their members. 9 034 Before the Business Unit, while we saw success, it was always [PCN] leadership doing the work at the side of their desks, and so more time was needed to get momentum on things. The Business Unit just expedited the process, laying the foundations for the work to happen faster. Which is required in a pandemic response. AHS = Alberta Health Services; IT = information technology; PCN = primary care network.
Note: Some administrators (ie, medical directors) occupy dual roles as independent clinicians.
SUPPLEMENTAL MATERIALS IN PDF FILE BELOW
- Leslie.pdf -
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- Leslie.pdf -
