Primary healthcare offers significant benefits to Canadians and to the healthcare system as a whole. The Taber Integrated Primary Healthcare Project (TIPHP) was a three-year primary healthcare renewal initiative involving rural physicians and the Chinook Health Region in Taber, Alberta, Canada. The goal of the project was to improve healthcare services delivery through integration of the services provided by the physician group and the health region in one rural community. Four main enablers emerged as fundamental to the integration process: community assessment and shared planning; evidence-based, interdisciplinary care; an integrated electronic information system; and investment in processes and structures that support change.The outcome of the project has been the implementation of a new model of healthcare delivery that embraces an integrated collaborative team approach in delivering population-based, primary healthcare. Importantly, the TIPHP has influenced regional healthcare policy related to primary healthcare renewal strategies and partnerships.

Introduction:In the last decade, Canadian provincial and territorial health systems have taken diverse approaches to strengthening primary care delivery. Although the Canadian and US systems differ in significant ways, important commonalities include the organization of care delivery, core principles guiding primary care reform, and some degree of provincial/state autonomy. This suggests that Canadian experiences, which employed a variety of tools, strategies, and policies, may be informative for US efforts to improve primary care.Innovations: The range of primary care reform initiatives implemented across Canada target organizational infrastructure, provider payment, health care workforce, and quality and safety. Primary care teams and networks in which multiple physicians work in concert with other providers have become widespread in some provinces; they vary on a number of dimensions, including physician payment, incorporation of other providers, and formal enrolment of patients. Family medicine is attracting more recent medical school graduates, a trend likely affected by new physician payment models, increases in the number of primary care providers, and efforts to better integrate nonphysician providers into clinical practice. Efforts to integrate electronic medical records into practice and pursue quality improvement strategies are gaining ground in some provinces.Conclusions: Canadian primary care reform initiatives rely on voluntary participation, incremental change, and diverse models, encouraging engagement and collaboration from a range of stakeholders including patients, providers, and policymakers. Cross-country collaboration in evaluating and translating Canada's primary care reform efforts are likely to yield important lessons for the US experience.

Health-care reform is perennially popular in Alberta, but reality doesn't match the rhetoric. Government has invested more than $700 million in Primary Care Networks-with little beyond anecdotal evidence of the value achieved with this investment. As the province redirects primary care to Family Care Clinics, the authors assert that simply tinkering with one part of the system is not the answer: health care must change on a system-wide basis. Drawing on the experiences of frontline staff and a rich body of literature, the authors present their vision for integrated team-based primary care, designed to be accountable to meet the needs of populations. This will require governance that makes primary care the hub of the system, and brings together government and health-services leadership to support the integration of primary and specialty care. There are shared accountabilities for achieving primary care that exhibits the attributes of high performing primary care systems, and these exist at multiple levels, from individuals seeking primary care, up to and including government. The authors make these accountabilities explicit, and outline strategies to secure their achievement that include system redesign, service delivery redesign and payment reform. All of this demands whole-system reform focused on primary care, and it won't be easy. There are plenty of vested interests at stake, and a truly transformative vision requires buy-in at every level. However, Alberta's rapidly growing and aging population makes it more urgent than ever to realize such a vision. This paper offers guidelines to spark the fresh thinking required. † We declare that two of our six authors are physicians currently practicing in PCN clinics in southern Alberta; both of these physicians are faculty of Alberta AIM. One of these physicians, Dr. Wedel, also co-chairs Alberta AIM. We also felt it important to declare from the outset that the authors come from a particular shared history: involvement in primary care reform in the former Chinook Health Region. This former health region has received numerous acknowledgments for its record of leading-edge reform around integrated primary care-we believe the lessons we have learned are still relevant, and applicable anywhere in the province. We also wish to state that despite this shared history, we come from different professional backgrounds and bring different perspectives. We have done our best to acknowledge and balance our biases as a team, and challenged one another to rise above any entrenched position. We fully acknowledge and accept, however, that as much as we believe that our experiences might be useful sources of practical wisdom, those same experiences could be legitimately criticized as sources of bias ACCOUNTABILITY BY DESIGN: MOVING PRIMARY CARE REFORM AHEAD IN ALBERTA The American writer Adam Hochschild tells us that, "Work is hard. Distractions are plentiful. And time is short." For us, this quote sums up where we are in relation to actually reforming (not just restructuring) the hea...

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