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Rego K, Jomy J, Patel P, DiDiodato G, Nademi A, Binnie A, Tsang J. The research activities of Ontario's large community hospitals: an updated scoping review. BMC Health Serv Res 2024; 24:1137. [PMID: 39334311 PMCID: PMC11429628 DOI: 10.1186/s12913-024-11454-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Accepted: 08/19/2024] [Indexed: 09/30/2024] Open
Abstract
BACKGROUND Community hospitals provide the majority of patient care in Canada but traditionally do not participate in clinical research. The disconnect between where most patients receive their health care and where health research is conducted leads to decreased study recruitment, reduced generalizability of study results, and inequitable patient access to novel therapies. A scoping review of the research activities of Ontario's large community hospitals (LCHs) between 2013 and 2015 reported an annualized output of 266 publications. In the last decade, efforts have been made to engage more community hospitals in research. In this updated scoping review, we provide a snapshot of the research activities of Ontario's LCHs between 2016 and 2022, describing the number and type of research publications as well as the frequency of collaboration within and between LCHs. METHODS Three medical databases (PubMed, Embase, and CINAHL) were searched for publications that included at least one author affiliated with one of Ontario's 47 LCHs, and for which the topic was hospital or health related. Screening and extraction occurred concurrently. RESULTS We identified 3,719 publications from 2016 to 22 with at least one Ontario LCH-affiliated author, representing an annualized output of 531 publications. The most frequent publication type was observational study (n = 1,654; 45%), quality improvement (n = 355; 10%), systematic reviews (n = 352; 9%) and randomized controlled trials (n = 325; 9%). The most common disciplines were outpatient care (n = 1,144; 31%), health systems research (n = 806; 22%), inpatient care (n = 437; 12%) and surgery (n = 403; 11%). LCH-affiliated first authors were identified in 997 (27%) publications, representing 755 unique authors, while LCH-affiliated senior authors were identified in 962 (26%) publications, representing 583 unique authors. Among the 1,565 studies with an LCH-affiliated first or senior author, 574 (37%) included collaborators from the same LCH and 86 (5%) included collaborators from other Ontario LCHs. CONCLUSIONS Health research by LCH-affiliated clinicians and researchers increased significantly in 2016-2022 relative to 2013-2015. Participation in randomized controlled trials however, remains low, suggesting that further efforts are required to build clinical research infrastructure in LCHs.
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Affiliation(s)
- Kian Rego
- Niagara Health Knowledge Institute, Niagara Health, St. Catharines, ON, Canada
- Department of Health Sciences, Brock University, St. Catharines, ON, Canada
| | - Jane Jomy
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Prey Patel
- Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Giulio DiDiodato
- Department of Critical Care Medicine, Royal Victoria Regional Health Centre, Barrie, ON, Canada
| | - Ashton Nademi
- Niagara Health Knowledge Institute, Niagara Health, St. Catharines, ON, Canada
| | | | - Jennifer Tsang
- Niagara Health Knowledge Institute, Niagara Health, St. Catharines, ON, Canada.
- Department of Medicine, McMaster University, Hamilton, ON, Canada.
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2
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Davidson M, Kielar A, Tonseth RP, Seland K, Harvie S, Hanneman K. The Landscape of Rural and Remote Radiology in Canada: Opportunities and Challenges. Can Assoc Radiol J 2024; 75:304-312. [PMID: 37638676 DOI: 10.1177/08465371231197953] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/29/2023] Open
Abstract
Diagnostic and interventional radiology play a crucial role in healthcare, facilitating diagnosis of disease, treatment planning, interventional therapies, and assessment for response to treatment. However, many rural and remote regions are disproportionately limited in accessing high-quality radiological services. Challenges include limited imaging infrastructure in these communities, geographic isolation, and workforce shortages impacting provision of interventional image-guided procedures and subspecialty imaging in particular. However, a career in rural or remote radiology also presents unique opportunities including a deep sense of community, broad scope of practice, and immense benefit to patient care. This review aims to explore the landscape of rural and remote radiology with a focus on Canada, including opportunities, challenges, and potential strategies. Some of the challenges are shared by both rural and remote communities while others are distinct. Factors that have contributed to challenges in recruitment and retention of rural and remote radiologists include workload burden, inadequate or suboptimal imaging and interventional equipment, and limited exposure during training. Additionally, strategies to improve the provision of radiology services in rural and remote communities are highlighted, addressing both the workforce shortage and the lack of essential equipment and other resources.
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Affiliation(s)
- Malcolm Davidson
- Temerty School of Medicine, University of Toronto, Toronto, ON, Canada
| | - Ania Kielar
- Department of Medical Imaging, University of Toronto, Toronto, ON, Canada
- University Medical Imaging Toronto, University Health Network, University of Toronto, Toronto, ON, Canada
| | | | - Karen Seland
- Department of Radiology, University of Northern British Columbia, Prince George, BC, Canada
| | - Sarah Harvie
- Department of Radiology, Buckley Valley District Hospital, Smithers, BC, Canada
| | - Kate Hanneman
- Department of Medical Imaging, University of Toronto, Toronto, ON, Canada
- University Medical Imaging Toronto, University Health Network, University of Toronto, Toronto, ON, Canada
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Théberge J, Smithman MA, Turgeon-Pelchat C, Tounkara FK, Richard V, Aubertin P, Léonard P, Alami H, Singhroy D, Fleet R. Through the big top: An exploratory study of circus-based artistic knowledge translation in rural healthcare services, Québec, Canada. PLoS One 2024; 19:e0302022. [PMID: 38635538 PMCID: PMC11025836 DOI: 10.1371/journal.pone.0302022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 03/26/2024] [Indexed: 04/20/2024] Open
Abstract
BACKGROUND The conventional methods and strategies used for knowledge translation (KT) in academic research often fall short in effectively reaching stakeholders, such as citizens, practitioners, and decision makers, especially concerning complex healthcare issues. In response, a growing number of scholars have been embracing arts-based knowledge translation (ABKT) to target a more diverse audience with varying backgrounds and expectations. Despite the increased interest, utilization, and literature on arts-based knowledge translation over the past three decades, no studies have directly compared traditional knowledge translation with arts-based knowledge translation methods. Thus, our study aimed to evaluate and compare the impact of an arts-based knowledge translation intervention-a circus show-with two traditional knowledge translation interventions (webinar and research report) in terms of awareness, accessibility, engagement, advocacy/policy influence, and enjoyment. METHODS To conduct this exploratory convergent mixed method study, we randomly assigned 162 participants to one of the three interventions. All three knowledge translation methods were used to translate the same research project: "Rural Emergency 360: Mobilization of decision-makers, healthcare professionals, patients, and citizens to improve healthcare and services in Quebec's rural emergency departments (UR360)." RESULTS The findings revealed that the circus show outperformed the webinar and research report in terms of accessibility and enjoyment, while being equally effective in raising awareness, increasing engagement, and influencing advocacy/policy. Each intervention strategy demonstrates its unique array of strengths and weaknesses, with the circus show catering to a diverse audience, while the webinar and research report target more informed participants. These outcomes underscore the innovative and inclusive attributes of Arts-Based Knowledge translation, showcasing its capacity to facilitate researchers' engagement with a wider array of stakeholders across diverse contexts. CONCLUSION As a relevant first step and a complementary asset, arts-based knowledge translation holds immense potential in increasing awareness and mobilization around crucial health issues.
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Affiliation(s)
- Julie Théberge
- Laval University, Québec, Canada
- Research Chair in Emergency Medicine Université-CISSS-CA, Lévis, Canada
- VITAM Centre de recherche en santé durable, Québec, Canada
- Centre de recherche, d’innovation et de transfert en arts du cirque, Montréal, Canada
| | | | | | | | - Véronique Richard
- Centre de recherche, d’innovation et de transfert en arts du cirque, Montréal, Canada
- University of Queensland, Brisbane, Australia
| | - Patrice Aubertin
- Centre de recherche, d’innovation et de transfert en arts du cirque, Montréal, Canada
| | | | | | | | - Richard Fleet
- Laval University, Québec, Canada
- Research Chair in Emergency Medicine Université-CISSS-CA, Lévis, Canada
- VITAM Centre de recherche en santé durable, Québec, Canada
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Almeida PFD, Silva KS, Bousquat A. Specialized care and health transport from a Health Care Network integration perspective. CIENCIA & SAUDE COLETIVA 2022. [DOI: 10.1590/1413-812320222710.07432022en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Abstract The aim of this study was to analyze the organization and provision of specialized care (SC) and health transport in regional polyclinics in the state of Bahia, Brazil. We conducted a qualitative exploratory single case study of a polyclinic based on semi-structured interviews with key informants in municipal and state health services. We sought to identify elements that characterize network-based models of SC. A number of advances were identified, including: an increase in the provision of SC and the scope and quality of services; effective retention of health professionals; provision of health transport; monitoring of SC; and improvements in the regulation of access to care through the use of computerized systems. The following challenges were observed: tailoring SC planning to regional health needs; the promotion of care coordination by Primary Health Care (PHC); the development of strategies to improve communication between SC and PHC professionals; institutionalization of counter-referral; engagement between the polyclinic and spaces for citizen participation; and fostering matrix support, permanent education, teaching-service integration, and research. Despite the intrinsic challenges of SC and the need to strengthen the central role of PHC, the regional polyclinic arrangement is better suited to the integration of the health care networks.
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Almeida PFD, Silva KS, Bousquat A. Specialized care and health transport from a Health Care Network integration perspective. CIENCIA & SAUDE COLETIVA 2022; 27:4025-4038. [PMID: 36134808 DOI: 10.1590/1413-812320222710.07432022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Accepted: 06/09/2022] [Indexed: 11/21/2022] Open
Abstract
The aim of this study was to analyze the organization and provision of specialized care (SC) and health transport in regional polyclinics in the state of Bahia, Brazil. We conducted a qualitative exploratory single case study of a polyclinic based on semi-structured interviews with key informants in municipal and state health services. We sought to identify elements that characterize network-based models of SC. A number of advances were identified, including: an increase in the provision of SC and the scope and quality of services; effective retention of health professionals; provision of health transport; monitoring of SC; and improvements in the regulation of access to care through the use of computerized systems. The following challenges were observed: tailoring SC planning to regional health needs; the promotion of care coordination by Primary Health Care (PHC); the development of strategies to improve communication between SC and PHC professionals; institutionalization of counter-referral; engagement between the polyclinic and spaces for citizen participation; and fostering matrix support, permanent education, teaching-service integration, and research. Despite the intrinsic challenges of SC and the need to strengthen the central role of PHC, the regional polyclinic arrangement is better suited to the integration of the health care networks.
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Affiliation(s)
- Patty Fidelis de Almeida
- Instituto de Saúde Coletiva, Universidade Federal Fluminense. R. Marquês de Paraná 303, 3º andar, anexo ao Hospital Universitário Antônio Pedro (Huap), Centro. 24220-000 Niterói RJ Brasil.
| | - Kamilla Santos Silva
- Instituto Multidisciplinar em Saúde, Universidade Federal da Bahia. Vitória da Conquista BA Brasil
| | - Aylene Bousquat
- Faculdade de Saúde Pública, Universidade de São Paulo. São Paulo SP Brasil
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Whittaker L, Pymar H, Liu XQ. Manual Uterine Aspiration in the Emergency Department as a first line therapy for early pregnancy loss: A single center retrospective study. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2022; 44:644-649. [PMID: 35248776 DOI: 10.1016/j.jogc.2022.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 02/03/2022] [Accepted: 02/04/2022] [Indexed: 10/18/2022]
Abstract
OBJECTIVES Manual uterine aspiration (MUA) is a currently underused management option for early pregnancy loss (EPL) in the emergency department (ED). This study addresses the safety and efficiency of MUA in the ED. METHODS We performed a single-site retrospective observational chart review of pregnant women presenting to the ED with vaginal bleeding and ED pathology submissions for products of conception (POC) between 2012 and 2016. Patients were excluded for gestational age >14 weeks, no evidence of pregnancy loss, uterine cavity anomaly, hemodynamic instability, or hemoglobin <80 g/L. We compared the frequencies of complications (need for blood transfusion, repeat ED visit, failed initial management, admission to hospital) and ED utilization time between 4 management options: expectant, misoprostol, MUA, and electric vacuum aspiration (EVA) outside the ED, as well as time to procedure between MUA and EVA. RESULTS A total of 162 patients were included with 123 (76%) having a pathology report positive for POC. The mean patient and gestational ages were 30 ± 7 years and 66 ± 17 days, respectively. One hundred and nine patients were managed expectantly, 9 were given misoprostol, 23 underwent MUA, and 21 underwent EVA. Composite complication rates were 40%, 33%, 9%, and 10% (P = 0.001), and mean ED times were 5.4, 4.9, 7.3, and 6.0 hours (P = 0.01), for expectant, misoprostol, MUA, and EVA, respectively. The mean time to procedure was 5.1 hours for MUA and 23.1 hours for EVA (p=0.002). CONCLUSIONS Integrating MUA in the ED has the potential to reduce health care resource utilization while improving patient care.
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Affiliation(s)
| | - Helen Pymar
- University of Manitoba ,WN5013 820 Sherbrook St Winnipeg, MB, R3H 1R9
| | - Xiao-Qing Liu
- University of Manitoba 807J- 715 McDermot Avenue. Winnipeg, MB. R3E 3P4
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Kerr L, Kealy B, Lim D, Walters L. Rural emergency departments: A systematic review to develop a resource typology relevant to developed countries. Aust J Rural Health 2021; 29:7-20. [PMID: 33567157 DOI: 10.1111/ajr.12702] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 11/19/2020] [Accepted: 11/25/2020] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE Despite low patient numbers, rural emergency departments have a similar diversity of case presentations as urban tertiary hospitals, with the need to manage high-acuity cases with limited resources. There are no consistent descriptions of the resources available to rural emergency departments internationally, limiting the capacity to compare clinical protocols and standards of care across similarly resourced units. This review aimed to describe the range of human, physical and specialist resources described in rural emergency departments in developed countries and propose a typology for use internationally. DESIGN AND SETTING A systematic literature search was performed for journal articles between 2000 and 2019 describing the staffing, access to radiology and laboratory investigations, and hospital inpatient specialists. RESULTS Considerable diversity in defining rurality and in resource access was found within and between Australia, New Zealand, Canada and USA. DISCUSSION A typology was developed to account for (a) emergency department staff on-floor, (b) emergency department staff on-call, (c) physical resources and (d) access to a specialist surgical service. This provides a valuable tool for relevant stakeholders to effectively communicate rural emergency department resources within a country and internationally. CONCLUSION The proposed five-tiered typology draws together international literature regarding rural emergency department services. Although further research is required to test this tool, the formation of this common language allows a base for effective communication between governments, training providers and policy-makers who are seeking to improve health systems and health outcomes.
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Affiliation(s)
- Lachlan Kerr
- College of Medicine and Public Health, Flinders University, Bedford Park, SA, Australia
| | - Benjamin Kealy
- College of Medicine and Public Health, Flinders University, Bedford Park, SA, Australia
| | - David Lim
- College of Medicine and Public Health, Flinders University, Bedford Park, SA, Australia.,School of Health Sciences, Western Sydney University, Campbelltown, NSW, Australia
| | - Lucie Walters
- College of Medicine and Public Health, Flinders University, Bedford Park, SA, Australia.,Adelaide Rural Clinical School, The University of Adelaide, Mount Gambier, SA, Australia
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Archambault PM, Rivard J, Smith PY, Sinha S, Morin M, LeBlanc A, Couturier Y, Pelletier I, Ghandour EK, Légaré F, Denis JL, Melady D, Paré D, Chouinard J, Kroon C, Huot-Lavoie M, Bert L, Witteman HO, Brousseau AA, Dallaire C, Sirois MJ, Émond M, Fleet R, Chandavong S. Learning Integrated Health System to Mobilize Context-Adapted Knowledge With a Wiki Platform to Improve the Transitions of Frail Seniors From Hospitals and Emergency Departments to the Community (LEARNING WISDOM): Protocol for a Mixed-Methods Implementation Study. JMIR Res Protoc 2020; 9:e17363. [PMID: 32755891 PMCID: PMC7439141 DOI: 10.2196/17363] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Accepted: 03/17/2020] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Elderly patients discharged from hospital experience fragmented care, repeated and lengthy emergency department (ED) visits, relapse into their earlier condition, and rapid cognitive and functional decline. The Acute Care for Elders (ACE) program at Mount Sinai Hospital in Toronto, Canada uses innovative strategies, such as transition coaches, to improve the care transition experiences of frail elderly patients. The ACE program reduced the lengths of hospital stay and readmission for elderly patients, increased patient satisfaction, and saved the health care system over Can $4.2 million (US $2.6 million) in 2014. In 2016, a context-adapted ACE program was implemented at one hospital in the Centre intégré de santé et de services sociaux de Chaudière-Appalaches (CISSS-CA) with a focus on improving transitions between hospitals and the community. The quality improvement project used an intervention strategy based on iterative user-centered design prototyping and a "Wiki-suite" (free web-based database containing evidence-based knowledge tools) to engage multiple stakeholders. OBJECTIVE The objectives of this study are to (1) implement a context-adapted CISSS-CA ACE program in four hospitals in the CISSS-CA and measure its impact on patient-, caregiver-, clinical-, and hospital-level outcomes; (2) identify underlying mechanisms by which our context-adapted CISSS-CA ACE program improves care transitions for the elderly; and (3) identify underlying mechanisms by which the Wiki-suite contributes to context-adaptation and local uptake of knowledge tools. METHODS Objective 1 will involve staggered implementation of the context-adapted CISSS-CA ACE program across the four CISSS-CA sites and interrupted time series to measure the impact on hospital-, patient-, and caregiver-level outcomes. Objectives 2 and 3 will involve a parallel mixed-methods process evaluation study to understand the mechanisms by which our context-adapted CISSS-CA ACE program improves care transitions for the elderly and by which our Wiki-suite contributes to adaptation, implementation, and scaling up of geriatric knowledge tools. RESULTS Data collection started in January 2019. As of January 2020, we enrolled 1635 patients and 529 caregivers from the four participating hospitals. Data collection is projected to be completed in January 2022. Data analysis has not yet begun. Results are expected to be published in 2022. Expected results will be presented to different key internal stakeholders to better support the effort and resources deployed in the transition of seniors. Through key interventions focused on seniors, we are expecting to increase patient satisfaction and quality of care and reduce readmission and ED revisit. CONCLUSIONS This study will provide evidence on effective knowledge translation strategies to adapt best practices to the local context in the transition of care for elderly people. The knowledge generated through this project will support future scale-up of the ACE program and our wiki methodology in other settings in Canada. TRIAL REGISTRATION ClinicalTrials.gov NCT04093245; https://clinicaltrials.gov/ct2/show/NCT04093245. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/17363.
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Affiliation(s)
- Patrick Michel Archambault
- Department of Family and Emergency Medicine, Université Laval, Québec, QC, Canada
- Centre intégré de santé et de services sociaux de Chaudière-Appalaches, Ste-Marie, QC, Canada
- VITAM - Centre de recherche en santé durable, Québec, QC, Canada
- Department of Anesthesiology and Critical Care Medicine, Division of Critical Care Medicine, Université Laval, Québec, QC, Canada
- Centre de recherche intégrée pour un système apprenant en santé et services sociaux, Centre intégré de santé et de services sociaux de Chaudière-Appalaches, Lévis, QC, Canada
| | - Josée Rivard
- Centre intégré de santé et de services sociaux de Chaudière-Appalaches, Ste-Marie, QC, Canada
| | - Pascal Y Smith
- Centre de recherche intégrée pour un système apprenant en santé et services sociaux, Centre intégré de santé et de services sociaux de Chaudière-Appalaches, Lévis, QC, Canada
| | - Samir Sinha
- Department of Medicine, Sinai Health System, Toronto, ON, Canada
- Department of Medicine, University Health Network, Toronto, QC, Canada
- Department of Medicine, University of Toronto, Toronto, QC, Canada
| | - Michèle Morin
- Centre intégré de santé et de services sociaux de Chaudière-Appalaches, Ste-Marie, QC, Canada
- Centre de recherche intégrée pour un système apprenant en santé et services sociaux, Centre intégré de santé et de services sociaux de Chaudière-Appalaches, Lévis, QC, Canada
- Department of Medicine, Faculty of Medicine, Université Laval, Québec, QC, Canada
| | - Annie LeBlanc
- Department of Family and Emergency Medicine, Université Laval, Québec, QC, Canada
- VITAM - Centre de recherche en santé durable, Québec, QC, Canada
| | - Yves Couturier
- Department of Social Work, University of Sherbrooke, Sherbrooke, QC, Canada
| | - Isabelle Pelletier
- Centre intégré de santé et de services sociaux de Chaudière-Appalaches, Ste-Marie, QC, Canada
- Centre de recherche intégrée pour un système apprenant en santé et services sociaux, Centre intégré de santé et de services sociaux de Chaudière-Appalaches, Lévis, QC, Canada
| | - El Kebir Ghandour
- VITAM - Centre de recherche en santé durable, Québec, QC, Canada
- Centre de recherche intégrée pour un système apprenant en santé et services sociaux, Centre intégré de santé et de services sociaux de Chaudière-Appalaches, Lévis, QC, Canada
- Institut national d'excellence en sante et en services sociaux, Québec, QC, Canada
| | - France Légaré
- Department of Family and Emergency Medicine, Université Laval, Québec, QC, Canada
- VITAM - Centre de recherche en santé durable, Québec, QC, Canada
- Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale (CIUSSS-CN), Québec, QC, Canada
- Canada Research Chair in Shared Decision Making and Knowledge Translation, Université Laval, Québec, QC, Canada
| | - Jean-Louis Denis
- Département de gestion, d'évaluation et de politique de santé, École de santé publique, Université de Montréal, Montreal, QC, Canada
| | - Don Melady
- Schwartz-Reisman Emergency Medicine Institute, Mount Sinai Hospital, Toronto, ON, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | - Daniel Paré
- Centre intégré de santé et de services sociaux de Chaudière-Appalaches, Ste-Marie, QC, Canada
| | - Josée Chouinard
- Centre intégré de santé et de services sociaux de Chaudière-Appalaches, Ste-Marie, QC, Canada
| | - Chantal Kroon
- Centre intégré de santé et de services sociaux de Chaudière-Appalaches, Ste-Marie, QC, Canada
| | - Maxime Huot-Lavoie
- Centre de recherche intégrée pour un système apprenant en santé et services sociaux, Centre intégré de santé et de services sociaux de Chaudière-Appalaches, Lévis, QC, Canada
- Faculty of Medicine, Université Laval, Québec, QC, Canada
| | - Laetitia Bert
- Centre de recherche intégrée pour un système apprenant en santé et services sociaux, Centre intégré de santé et de services sociaux de Chaudière-Appalaches, Lévis, QC, Canada
- Faculty of Nursing, Université Laval, Québec, QC, Canada
| | - Holly O Witteman
- Department of Family and Emergency Medicine, Université Laval, Québec, QC, Canada
- VITAM - Centre de recherche en santé durable, Québec, QC, Canada
- Office of Education and Professional Development, Faculty of Medicine, Université Laval, Québec, QC, Canada
- CHU de Québec-Université Laval, Québec, QC, Canada
| | - Audrey-Anne Brousseau
- Centre intégré universitaire de santé et de services sociaux de l'Estrie - CHUS, Sherbrooke, QC, Canada
| | - Clémence Dallaire
- Centre de recherche intégrée pour un système apprenant en santé et services sociaux, Centre intégré de santé et de services sociaux de Chaudière-Appalaches, Lévis, QC, Canada
- Faculty of Nursing, Université Laval, Québec, QC, Canada
| | - Marie-Josée Sirois
- VITAM - Centre de recherche en santé durable, Québec, QC, Canada
- Centre d'excellence sur le vieillissement du Québec, Hôpital du Saint-Sacrement, Québec, QC, Canada
- Département de réadaptation, Faculté de médecine, Université Laval, Québec, QC, Canada
| | - Marcel Émond
- Department of Family and Emergency Medicine, Université Laval, Québec, QC, Canada
- VITAM - Centre de recherche en santé durable, Québec, QC, Canada
- CHU de Québec-Université Laval, Québec, QC, Canada
| | - Richard Fleet
- Department of Family and Emergency Medicine, Université Laval, Québec, QC, Canada
- VITAM - Centre de recherche en santé durable, Québec, QC, Canada
- Centre de recherche intégrée pour un système apprenant en santé et services sociaux, Centre intégré de santé et de services sociaux de Chaudière-Appalaches, Lévis, QC, Canada
| | - Sam Chandavong
- Centre de recherche intégrée pour un système apprenant en santé et services sociaux, Centre intégré de santé et de services sociaux de Chaudière-Appalaches, Lévis, QC, Canada
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Morgan JM, Calleja P. Emergency trauma care in rural and remote settings: Challenges and patient outcomes. Int Emerg Nurs 2020; 51:100880. [PMID: 32622226 DOI: 10.1016/j.ienj.2020.100880] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Revised: 04/16/2020] [Accepted: 05/07/2020] [Indexed: 12/01/2022]
Abstract
INTRODUCTION Trauma is a global public health concern, with higher mortality rates acknowledged in rural and remote populations. Research to understand this phenomenon and to improve patient outcomes is therefore vital. Trauma systems have been developed to provide specialty care to patients in an attempt to improve mortality rates. However, not all trauma systems are created equally as distance and remoteness has a significant impact on the capabilities of the larger trauma systems that service vast geographical distances. The primary objective of this integrative literature review was to examine the challenges associated with providing emergency trauma care to rural and remote populations and the associated patient outcomes. The secondary objective was to explore strategies to improve trauma patient outcomes. METHODS An integrative review approach was used to inform the methods of this study. A systematic search of databases including CINAHL, Medline, EmBase, Proquest, Scopus, and Science Direct was undertaken. Other search methods included hand searching journal references. RESULTS 2157 articles were identified for screening and 87 additional papers were located by hand searching. Of these, 49 were included in this review. Current evidence reveals that rural and remote populations face unique challenges in the provision of emergency trauma care such as large distances, delays transferring patients to definitive care, limited resources in rural settings, specific contextual challenges, population specific risk factors, weather and seasonal factors and the availability and skill of trained trauma care providers. Consequently, rural and remote populations often experience higher mortality rates in comparison to urban populations although this may be different for specific mechanisms of injury or population subsets. While an increased risk of death was associated with an increase in remoteness, research also found it costs substantially less to provide care to rural patients in their rural environment than their urban counterparts. Other factors found to influence mortality rates were severity of injury and differences in characteristics between rural and urban populations. Trauma systems vary around the world and must address local issues that may be affected by distance, geography, seasonal population variations, specific population risk factors, trauma network operationalisation, referral and retrieval and involvement of hospitals and services which have no trauma designation. CONCLUSIONS The challenges acknowledged for rural and remote trauma patients may be lessened and mortality rates improved by implementing strategies such as telemedicine, trauma training and the expansion of trauma systems that are responsive to local needs and resources. Additional research to determine which of these challenges has the most significant impact on health outcomes for rural patients is required in an effort to reduce existing discrepancies. Emphasis on embracing and expanding inclusive planning for complex trauma systems, as well as strategies aimed at understanding the issues rural and remote clinicians face, will also assist to achieve this.
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Affiliation(s)
- Janita M Morgan
- School of Nursing and Midwifery, Griffith University, 170 Kessels Road, Nathan 4111, QLD, Australia; Gympie Hospital, Queensland Health, 12 Henry Street, Gympie 4570, QLD, Australia.
| | - Pauline Calleja
- School of Nursing and Midwifery, Griffith University, 170 Kessels Road, Nathan 4111, QLD, Australia; School of Nursing Midwifery & Social Sciences, CQUniversity, Level 3 Cairns Square, Corner Abbott and Shields Street, Cairns 4870, QLD, Australia; Retrieval Services Queensland, Department of Health, 125 Kedron Park Road, Kedron 4031, QLD, Australia.
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Abstract
BACKGROUND Amyotrophic lateral sclerosis (ALS) is a progressive motor neuron disease resulting in muscle weakness, dysarthria and dysphagia, and ultimately respiratory failure leading to death. Half of the ALS patients survive less than 3 years, and 80% of the patients survive less than 5 years. Riluzole is the only approved medication in Canada with randomized controlled clinical trial evidence to slow the progression of ALS, albeit only to a modest degree. The Canadian Neuromuscular Disease Registry (CNDR) collects data on over 140 different neuromuscular diseases including ALS across ten academic institutions and 28 clinics including ten multidisciplinary ALS clinics. METHODS In this study, CNDR registry data were analyzed to examine potential differences in ALS care among provinces in time to diagnosis, riluzole and feeding tube use. RESULTS Significant differences were found among provinces, in time to diagnosis from symptom onset, in the use of riluzole and in feeding tube use. CONCLUSIONS Future investigations should be undertaken to identify factors contributing to such differences, and to propose potential interventions to address the provincial differences reported.
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Fleet R, Lauzier F, Tounkara FK, Turcotte S, Poitras J, Morris J, Ouimet M, Fortin JP, Plant J, Légaré F, Dupuis G, Turgeon-Pelchat C. Profile of trauma mortality and trauma care resources at rural emergency departments and urban trauma centres in Quebec: a population-based, retrospective cohort study. BMJ Open 2019; 9:e028512. [PMID: 31160276 PMCID: PMC6549736 DOI: 10.1136/bmjopen-2018-028512] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES As Canada's second largest province, the geography of Quebec poses unique challenges for trauma management. Our primary objective was to compare mortality rates between trauma patients treated at rural emergency departments (EDs) and urban trauma centres in Quebec. As a secondary objective, we compared the availability of trauma care resources and services between these two settings. DESIGN Retrospective cohort study. SETTING 26 rural EDs and 33 level 1 and 2 urban trauma centres in Quebec, Canada. PARTICIPANTS 79 957 trauma cases collected from Quebec's trauma registry. PRIMARY AND SECONDARY OUTCOME MEASURES Our primary outcome measure was mortality (prehospital, ED, in-hospital). Secondary outcome measures were the availability of trauma-related services and staff specialties at rural and urban facilities. Multivariable generalised linear mixed models were used to determine the relationship between the primary facility and mortality. RESULTS Overall, 7215 (9.0%) trauma patients were treated in a rural ED and 72 742 (91.0%) received treatment at an urban centre. Mortality rates were higher in rural EDs compared with urban trauma centres (13.3% vs 7.9%, p<0.001). After controlling for available potential confounders, the odds of prehospital or ED mortality were over three times greater for patients treated in a rural ED (OR 3.44, 95% CI 1.88 to 6.28). Trauma care setting (rural vs urban) was not associated with in-hospital mortality. Nearly all of the specialised services evaluated were more present at urban trauma centres. CONCLUSIONS Trauma patients treated in rural EDs had a higher mortality rate and were more likely to die prehospital or in the ED compared with patients treated at an urban trauma centre. Our results were limited by a lack of accurate prehospital times in the trauma registry.
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Affiliation(s)
- Richard Fleet
- Médecine familiale et médecine d’urgence, Universite Laval, Quebec, Canada
- Centre de recherche du CISSS Chaudière-Appalaches, Chaire de recherche en médecine d’urgence ULaval - CISSS Chaudière-Appalaches, Lévis, Canada
| | - François Lauzier
- Population Health and Optimal Health Practices Research Unit (Trauma - Emergency - Critical Care Medicine), Centre de Recherche du CHU de Québec - Université Laval, Quebec, Canada
- Department of Anesthesiology and Critical Care Medicine, Universite Laval, Quebec, Canada
| | - Fatoumata Korinka Tounkara
- Centre de recherche du CISSS Chaudière-Appalaches, Chaire de recherche en médecine d’urgence ULaval - CISSS Chaudière-Appalaches, Lévis, Canada
| | - Stéphane Turcotte
- Centre de recherche du CISSS Chaudière-Appalaches, CISSS Chaudière-Appalaches, Lévis, Canada
| | | | - Judy Morris
- Emergency Medicine department, HSCM, Montreal, Canada
| | | | - Jean-Paul Fortin
- Centre integre universitaire de sante et de services sociaux de la Capitale-Nationale, Quebec, Canada
| | - Jeff Plant
- Department of Emergency Medicine, University of British Columbia, Vancouver, Canada
| | - France Légaré
- Family and Emergency Medicine, Université Laval, Québec, Canada
| | - Gilles Dupuis
- Psychology, Université du Québec à Montréal, Montreal, Canada
| | - Catherine Turgeon-Pelchat
- Centre de recherche du CISSS Chaudière-Appalaches, Chaire de recherche en médecine d’urgence ULaval - CISSS Chaudière-Appalaches, Lévis, Canada
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Hiebert B, Regan S, Leipert B. Tokenism and Mending Fences: How Rural Male Farmers and Their Health Needs Are Discussed in Health Policy and Planning Documents. Healthc Policy 2018; 13:50-64. [PMID: 30052189 PMCID: PMC6044262 DOI: 10.12927/hcpol.2018.25494] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Rural male farmers (RMFs) are an understudied population with high mortality, morbidity and co-morbidities due to preventable injury, most of which occur on-farm. This study examines how RMFs and their health needs are discussed in Ontario rural health policy documents. A retrospective analysis of policy was conducted to analyze the content of Ontario rural healthcare policy documents published since 2006. Discussions of RMFs were categorized by two themes: tokenism and mending fences. Tokenism refers to RMFs' invisibility, except when farming stereotypes were used to describe rural areas. Mending fences captures the desire of rural communities to be included in healthcare decisions, and to position RMFs as key stakeholders for healthcare organizations to engage with to improve how they are perceived by rural communities. This study asserts that including RMFs in health policy formation can improve rural healthcare delivery and relationships between rural healthcare organizations and the communities they serve.
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Affiliation(s)
- Bradley Hiebert
- Doctoral Candidate, Department of Health Information Sciences, Western University, London, ON
| | - Sandra Regan
- Adjunct Associate Professor, Arthur Labatt Family School of Nursing, Western University, London, ON
| | - Beverly Leipert
- Professor, Arthur Labatt Family School of Nursing, Western University, London, ON
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Fleet R, Bussières S, Tounkara FK, Turcotte S, Légaré F, Plant J, Poitras J, Archambault PM, Dupuis G. Rural versus urban academic hospital mortality following stroke in Canada. PLoS One 2018; 13:e0191151. [PMID: 29385173 PMCID: PMC5791969 DOI: 10.1371/journal.pone.0191151] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Accepted: 12/31/2017] [Indexed: 12/03/2022] Open
Abstract
Introduction Stroke is one of the leading causes of death in Canada. While stroke care has improved dramatically over the last decade, outcomes following stroke among patients treated in rural hospitals have not yet been reported in Canada. Objectives To describe variation in 30-day post-stroke in-hospital mortality rates between rural and urban academic hospitals in Canada. We also examined 24/7 in-hospital access to CT scanners and selected services in rural hospitals. Materials and methods We included Canadian Institute for Health Information (CIHI) data on adjusted 30-day in-hospital mortality following stroke from 2007 to 2011 for all acute care hospitals in Canada excluding Quebec and the Territories. We categorized rural hospitals as those located in rural small towns providing 24/7 emergency physician coverage with inpatient beds. Urban hospitals were academic centres designated as Level 1 or 2 trauma centres. We computed descriptive data on local access to a CT scanner and other services and compared mean 30-day adjusted post-stroke mortality rates for rural and urban hospitals to the overall Canadian rate. Results A total of 286 rural hospitals (3.4 million emergency department (ED) visits/year) and 24 urban hospitals (1.5 million ED visits/year) met inclusion criteria. From 2007 to 2011, 30-day in-hospital mortality rates following stroke were significantly higher in rural than in urban hospitals and higher than the Canadian average for every year except 2008 (rural average range = 18.26 to 21.04 and urban average range = 14.11 to 16.78). Only 11% of rural hospitals had a CT-scanner, 1% had MRI, 21% had in-hospital ICU, 94% had laboratory and 92% had basic x-ray facilities. Conclusion Rural hospitals in Canada had higher 30-day in-hospital mortality rates following stroke than urban academic hospitals and the Canadian average. Rural hospitals also have very limited local access to CT scanners and ICUs. These rural/urban discrepancies are cause for concern in the context of Canada’s universal health care system.
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Affiliation(s)
- Richard Fleet
- Department of Family Medicine and Emergency Medicine, Université Laval, Québec, QC, Canada
- Research Chair in Emergency Medicine Université Laval-CHAU Hôtel-Dieu de Lévis, Lévis, QC, Canada
- * E-mail:
| | - Sylvain Bussières
- Research Chair in Emergency Medicine Université Laval-CHAU Hôtel-Dieu de Lévis, Lévis, QC, Canada
| | | | - Stéphane Turcotte
- Population Health and Practice-Changing Research Group, CHU de Québec Research Centre, Québec, QC, Canada
| | - France Légaré
- Department of Family Medicine and Emergency Medicine and Knowledge Transfer and Health Technology Assessment Group, CHU de Québec Research Centre and Evaluative Research Unit, Université Laval, Québec, QC, Canada
| | - Jeff Plant
- Faculty of Medicine, University of British Columbia and Department of Emergency Medicine, Penticton Regional Hospital, Penticton, BC, Canada
| | - Julien Poitras
- Department of Family Medicine and Emergency Medicine, Université Laval, Québec, QC, Canada
- Research Chair in Emergency Medicine Université Laval-CHAU Hôtel-Dieu de Lévis, Lévis, QC, Canada
| | - Patrick M. Archambault
- Department of Family Medicine and Emergency Medicine, Université Laval, Québec, QC, Canada
- Research Chair in Emergency Medicine Université Laval-CHAU Hôtel-Dieu de Lévis, Lévis, QC, Canada
- Intensive Care Division, Department of Anesthesiology, Université Laval, Quebec, QC, Canada
| | - Gilles Dupuis
- Department of Psychology, Université du Québec à Montréal, Montréal, QC, Canada
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Bergeron C, Fleet R, Tounkara FK, Lavallée-Bourget I, Turgeon-Pelchat C. Lack of CT scanner in a rural emergency department increases inter-facility transfers: a pilot study. BMC Res Notes 2017; 10:772. [PMID: 29282113 PMCID: PMC5745590 DOI: 10.1186/s13104-017-3071-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Accepted: 12/06/2017] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE Rural emergency departments (EDs) are an important gateway to care for the 20% of Canadians who reside in rural areas. Less than 15% of Canadian rural EDs have access to a computed tomography (CT) scanner. We hypothesized that a significant proportion of inter-facility transfers from rural hospitals without CT scanners are for CT imaging. Our objective was to assess inter-facility transfers for CT imaging in a rural ED without a CT scanner. RESULTS We selected a rural ED that offers 24/7 medical care with admission beds but no CT scanner. Descriptive statistics were collected from 2010 to 2015 on total ED visits and inter-facility transfers. Data was accessible through hospital and government databases. Between 2010 and 2014, there were respectively 13,531, 13,524, 13,827, 12,883, and 12,942 ED visits, with an average of 444 inter-facility transfers. An average of 33% (148/444) of inter-facility transfers were to a rural referral centre with a CT scan, with 84% being for CT scan. Inter-facility transfers incur costs and potential delays in patient diagnosis and management, yet current databases could not capture transfer times. Acquiring a CT scan may represent a reasonable opportunity for the selected rural hospital considering the number of required transfers.
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Affiliation(s)
- Catherine Bergeron
- Chaire de recherche en médecine d’urgence de l’Université Laval, CHAU Hôtel-Dieu de Lévis, 143 Rue Wolfe, Lévis, QC G6V 3Z1 Canada
| | - Richard Fleet
- Chaire de recherche en médecine d’urgence de l’Université Laval, CHAU Hôtel-Dieu de Lévis, 143 Rue Wolfe, Lévis, QC G6V 3Z1 Canada
- Department of Family Medicine and Emergency Medicine, Université Laval, 1050, Avenue de la Médecine, Québec City, QC G1V 0A6 Canada
| | - Fatoumata Korika Tounkara
- Chaire de recherche en médecine d’urgence de l’Université Laval, CHAU Hôtel-Dieu de Lévis, 143 Rue Wolfe, Lévis, QC G6V 3Z1 Canada
| | - Isabelle Lavallée-Bourget
- Chaire de recherche en médecine d’urgence de l’Université Laval, CHAU Hôtel-Dieu de Lévis, 143 Rue Wolfe, Lévis, QC G6V 3Z1 Canada
| | - Catherine Turgeon-Pelchat
- Chaire de recherche en médecine d’urgence de l’Université Laval, CHAU Hôtel-Dieu de Lévis, 143 Rue Wolfe, Lévis, QC G6V 3Z1 Canada
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The Quebec emergency department guide: A cross-sectional study to evaluate its use, perceived usefulness, and implementation in rural emergency departments. CAN J EMERG MED 2017; 21:103-110. [PMID: 29212567 DOI: 10.1017/cem.2017.423] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVES The Quebec Emergency Department Management Guide (QEDMG) is a unique document with 78 recommendations designed to improve the organization of emergency departments (EDs) in the province of Quebec. However, no study has examined how this guide is perceived or used by rural health care management. METHODS We invited all directors of professional services (DPS), directors of nursing services (DNS), head nurses (HN), and emergency department directors (EDD) working in Quebec's rural hospitals to complete an online survey (144 questions). Simple frequency analyses (percentage [%] and 95% confidence interval) were conducted to establish general familiarity and use of the QEDMG, as well as perceived usefulness and implementation of its recommendations. RESULTS Seventy-three percent (19/26) of Quebec's rural EDs participated in the study. A total of 82% (62/76) of the targeted stakeholders participated. Sixty-one percent of respondents reported being "moderately or a lot" familiar with the QEDMG, whereas 77% reported "almost never or sometimes" refer to this guide. Physician management (DPS, EDD) were more likely than nursing management (DNS and especially HN) to report "not at all" or "little" familiarity on use of the guide. Finally, 98% of the QEDMG recommendations were considered useful. CONCLUSIONS Although the QEDMG is considered a useful guide for rural EDs, it is not optimally known or used in rural EDs, especially by physician management. Stakeholders should consider these findings before implementing the revised versions of the QEDMG.
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Fleet R, Dupuis G, Fortin JP, Gravel J, Ouimet M, Poitras J, Légaré F. Rural emergency care 360°: mobilising healthcare professionals, decision-makers, patients and citizens to improve rural emergency care in the province of Quebec, Canada: a qualitative study protocol. BMJ Open 2017; 7:e016039. [PMID: 28819068 PMCID: PMC5629661 DOI: 10.1136/bmjopen-2017-016039] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION Emergency departments (EDs) are an important safety net for rural populations. Results of our earlier studies suggest that rural Canadian hospitals have limited access to advanced imaging services and intensive care units and that patients are transferred over large distances. They also revealed significant geographical variations in rural services. In the absence of national standards, our studies raise questions about inequities in rural access to emergency services and the risks for citizens. Our goal is to build recommendations for improving services by mobilising stakeholders interested in rural emergency care. With help and full engagement of stakeholders, we will (1) identify solutions for improving quality and performance in rural EDs; (2) formulate and prioritise recommendations; (3) transfer knowledge of the recommendations to rural EDs and support operationalisation and (4) assess knowledge transfer and explore further impacts of this participatory action research project. METHODOLOGY We will use a participatory action research approach. We will plan for a governance structure that includes all stakeholders’ representatives, so throughout this project, stakeholders are fully engaged at every step. Our sample will be 26 EDs in rural Quebec. We will conduct semistructured individual and focus group interviews with relevant and representative participants, including patients and citizens (estimated n=200). Interviews will be thematically analysed to extract potential solutions and other qualitative information.An expert panel (±15) will use an analysis grid to develop consensus recommendations from solutions suggested and will evaluate feasibility, impacts, costs, conditions for implementation and establish monitoring indicators. Recommendations will be transferred to stakeholders using tailored knowledge translation strategies (web platform, meetings and so on). DISCUSSION AND EXPECTED RESULTS This study will result in a comprehensive consensus list of feasible and high-priority recommendations enabling decision-makers in emergency care to implement improvements in rural emergency care in Quebec. ETHICS AND DISSEMINATION This protocol has been approved by the CSSS Alphonse-Desjardins research ethics committee (Project number: MP 2017-009). The qualitative material will be kept confidential and the data will be presented in a way that respects confidentiality. The dissemination plan for the study includes publications in scientific and professional journals. We will also use social media to disseminate our findings and activities such as communications in public conferences.
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Affiliation(s)
- Richard Fleet
- Department of Family and Emergency Medicine, Université Laval, Quebec City, Québec, Canada
- Research Chair in Emergency Medicine, CHAU-Hôtel-Dieu de Lévis (Université Laval), Lévis, Québec, Canada
- Institut universitaire de première ligne en santé et services sociaux -Université Laval, Québec city, Québec, Canada
| | - Gilles Dupuis
- Department of Psychology, Université du Québec à Montréal, Montreal, Québec, Canada
| | - Jean-Paul Fortin
- Institut universitaire de première ligne en santé et services sociaux -Université Laval, Québec city, Québec, Canada
- Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, Québec, Canada
| | - Jocelyn Gravel
- CHU Sainte-Justine, Université de Montréal, Montréal, Canada
| | - Mathieu Ouimet
- Department of Political Science, Université Laval, Quebec City, Québec, Canada
| | - Julien Poitras
- Department of Family and Emergency Medicine, Université Laval, Quebec City, Québec, Canada
- Research Chair in Emergency Medicine, CHAU-Hôtel-Dieu de Lévis (Université Laval), Lévis, Québec, Canada
| | - France Légaré
- Institut universitaire de première ligne en santé et services sociaux -Université Laval, Québec city, Québec, Canada
- Department of Family Medicine and Emergency Medicine, Knowledge Transfer and Health Technology Assessment Group of the CHU de Québec Research Centre, Unité de Recherche Évaluative, Université Laval, Quebec City, Québec, Canada
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Layani G, Fleet R, Dallaire R, Tounkara FK, Poitras J, Archambault P, Chauny JM, Ouimet M, Gauthier J, Dupuis G, Tanguay A, Lévesque JF, Simard-Racine G, Haggerty J, Légaré F. The challenges of measuring quality-of-care indicators in rural emergency departments: a cross-sectional descriptive study. CMAJ Open 2016; 4:E398-E403. [PMID: 27730103 PMCID: PMC5047798 DOI: 10.9778/cmajo.20160007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Evidence-based indicators of quality of care have been developed to improve care and performance in Canadian emergency departments. The feasibility of measuring these indicators has been assessed mainly in urban and academic emergency departments. We sought to assess the feasibility of measuring quality-of-care indicators in rural emergency departments in Quebec. METHODS We previously identified rural emergency departments in Quebec that offered medical coverage with hospital beds 24 hours a day, 7 days a week and were located in rural areas or small towns as defined by Statistics Canada. A standardized protocol was sent to each emergency department to collect data on 27 validated quality-of-care indicators in 8 categories: duration of stay, patient safety, pain management, pediatrics, cardiology, respiratory care, stroke and sepsis/infection. Data were collected by local professional medical archivists between June and December 2013. RESULTS Fifteen (58%) of the 26 emergency departments invited to participate completed data collection. The ability to measure the 27 quality-of-care indicators with the use of databases varied across departments. Centres 2, 5, 6 and 13 used databases for at least 21 of the indicators (78%-92%), whereas centres 3, 8, 9, 11, 12 and 15 used databases for 5 (18%) or fewer of the indicators. On average, the centres were able to measure only 41% of the indicators using heterogeneous databases and manual extraction. The 15 centres collected data from 15 different databases or combinations of databases. The average data collection time for each quality-of-care indicator varied from 5 to 88.5 minutes. The median data collection time was 15 minutes or less for most indicators. INTERPRETATION Quality-of-care indicators were not easily captured with the use of existing databases in rural emergency departments in Quebec. Further work is warranted to improve standardized measurement of these indicators in rural emergency departments in the province and to generalize the information gathered in this study to other health care environments.
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Affiliation(s)
- Géraldine Layani
- Research Chair in Emergency Medicine Université Laval - Centre hospitalier affilié universitaire Hôtel-Dieu de Lévis (Layani, Fleet, Dallaire, Tounkara, Archambault, Tanguay), Lévis; Department of Family and Emergency Medicine (Fleet, Poitras, Archambault); Intensive Care Division (Archambault), Department of Anesthesiology, Université Laval, Québec; Department of Family and Emergency Medicine (Chauny), Université de Montréal, Hôpital du Sacré-Coeur de Montréal, Montréal; Department of Political Science (Ouimet), Université Laval, Québec; Health Care Services Systems Analysis and Evaluation Directorate(Gauthier), Quebec Public Health Institute, Université du Québec à Rimouski, Rimouski; Department of Psychology (Dupuis), Université du Québec à Montréal, Montréal, Que.; Centre for Primary Health Care and Equity (Lévesque), Faculty of Medicine, University of New South Wales, Sydney, Australia; Department of Emergency Medicine (Simard-Racine), Centre de santé et de services sociaux de La Matapédia, Amqui; McGill Chair in Family and Community Medicine Research (Haggerty), St. Mary's Hospital Centre and McGill University, Montréal; Department of Family Medicine and Emergency Medicine and Knowledge Transfer and Health Technology Assessment Group, Centre hospitalier universitaire de Québec Research Centre (Légaré), Evaluative Research Unit, Université Laval, Québec, Que
| | - Richard Fleet
- Research Chair in Emergency Medicine Université Laval - Centre hospitalier affilié universitaire Hôtel-Dieu de Lévis (Layani, Fleet, Dallaire, Tounkara, Archambault, Tanguay), Lévis; Department of Family and Emergency Medicine (Fleet, Poitras, Archambault); Intensive Care Division (Archambault), Department of Anesthesiology, Université Laval, Québec; Department of Family and Emergency Medicine (Chauny), Université de Montréal, Hôpital du Sacré-Coeur de Montréal, Montréal; Department of Political Science (Ouimet), Université Laval, Québec; Health Care Services Systems Analysis and Evaluation Directorate(Gauthier), Quebec Public Health Institute, Université du Québec à Rimouski, Rimouski; Department of Psychology (Dupuis), Université du Québec à Montréal, Montréal, Que.; Centre for Primary Health Care and Equity (Lévesque), Faculty of Medicine, University of New South Wales, Sydney, Australia; Department of Emergency Medicine (Simard-Racine), Centre de santé et de services sociaux de La Matapédia, Amqui; McGill Chair in Family and Community Medicine Research (Haggerty), St. Mary's Hospital Centre and McGill University, Montréal; Department of Family Medicine and Emergency Medicine and Knowledge Transfer and Health Technology Assessment Group, Centre hospitalier universitaire de Québec Research Centre (Légaré), Evaluative Research Unit, Université Laval, Québec, Que
| | - Renée Dallaire
- Research Chair in Emergency Medicine Université Laval - Centre hospitalier affilié universitaire Hôtel-Dieu de Lévis (Layani, Fleet, Dallaire, Tounkara, Archambault, Tanguay), Lévis; Department of Family and Emergency Medicine (Fleet, Poitras, Archambault); Intensive Care Division (Archambault), Department of Anesthesiology, Université Laval, Québec; Department of Family and Emergency Medicine (Chauny), Université de Montréal, Hôpital du Sacré-Coeur de Montréal, Montréal; Department of Political Science (Ouimet), Université Laval, Québec; Health Care Services Systems Analysis and Evaluation Directorate(Gauthier), Quebec Public Health Institute, Université du Québec à Rimouski, Rimouski; Department of Psychology (Dupuis), Université du Québec à Montréal, Montréal, Que.; Centre for Primary Health Care and Equity (Lévesque), Faculty of Medicine, University of New South Wales, Sydney, Australia; Department of Emergency Medicine (Simard-Racine), Centre de santé et de services sociaux de La Matapédia, Amqui; McGill Chair in Family and Community Medicine Research (Haggerty), St. Mary's Hospital Centre and McGill University, Montréal; Department of Family Medicine and Emergency Medicine and Knowledge Transfer and Health Technology Assessment Group, Centre hospitalier universitaire de Québec Research Centre (Légaré), Evaluative Research Unit, Université Laval, Québec, Que
| | - Fatoumata K Tounkara
- Research Chair in Emergency Medicine Université Laval - Centre hospitalier affilié universitaire Hôtel-Dieu de Lévis (Layani, Fleet, Dallaire, Tounkara, Archambault, Tanguay), Lévis; Department of Family and Emergency Medicine (Fleet, Poitras, Archambault); Intensive Care Division (Archambault), Department of Anesthesiology, Université Laval, Québec; Department of Family and Emergency Medicine (Chauny), Université de Montréal, Hôpital du Sacré-Coeur de Montréal, Montréal; Department of Political Science (Ouimet), Université Laval, Québec; Health Care Services Systems Analysis and Evaluation Directorate(Gauthier), Quebec Public Health Institute, Université du Québec à Rimouski, Rimouski; Department of Psychology (Dupuis), Université du Québec à Montréal, Montréal, Que.; Centre for Primary Health Care and Equity (Lévesque), Faculty of Medicine, University of New South Wales, Sydney, Australia; Department of Emergency Medicine (Simard-Racine), Centre de santé et de services sociaux de La Matapédia, Amqui; McGill Chair in Family and Community Medicine Research (Haggerty), St. Mary's Hospital Centre and McGill University, Montréal; Department of Family Medicine and Emergency Medicine and Knowledge Transfer and Health Technology Assessment Group, Centre hospitalier universitaire de Québec Research Centre (Légaré), Evaluative Research Unit, Université Laval, Québec, Que
| | - Julien Poitras
- Research Chair in Emergency Medicine Université Laval - Centre hospitalier affilié universitaire Hôtel-Dieu de Lévis (Layani, Fleet, Dallaire, Tounkara, Archambault, Tanguay), Lévis; Department of Family and Emergency Medicine (Fleet, Poitras, Archambault); Intensive Care Division (Archambault), Department of Anesthesiology, Université Laval, Québec; Department of Family and Emergency Medicine (Chauny), Université de Montréal, Hôpital du Sacré-Coeur de Montréal, Montréal; Department of Political Science (Ouimet), Université Laval, Québec; Health Care Services Systems Analysis and Evaluation Directorate(Gauthier), Quebec Public Health Institute, Université du Québec à Rimouski, Rimouski; Department of Psychology (Dupuis), Université du Québec à Montréal, Montréal, Que.; Centre for Primary Health Care and Equity (Lévesque), Faculty of Medicine, University of New South Wales, Sydney, Australia; Department of Emergency Medicine (Simard-Racine), Centre de santé et de services sociaux de La Matapédia, Amqui; McGill Chair in Family and Community Medicine Research (Haggerty), St. Mary's Hospital Centre and McGill University, Montréal; Department of Family Medicine and Emergency Medicine and Knowledge Transfer and Health Technology Assessment Group, Centre hospitalier universitaire de Québec Research Centre (Légaré), Evaluative Research Unit, Université Laval, Québec, Que
| | - Patrick Archambault
- Research Chair in Emergency Medicine Université Laval - Centre hospitalier affilié universitaire Hôtel-Dieu de Lévis (Layani, Fleet, Dallaire, Tounkara, Archambault, Tanguay), Lévis; Department of Family and Emergency Medicine (Fleet, Poitras, Archambault); Intensive Care Division (Archambault), Department of Anesthesiology, Université Laval, Québec; Department of Family and Emergency Medicine (Chauny), Université de Montréal, Hôpital du Sacré-Coeur de Montréal, Montréal; Department of Political Science (Ouimet), Université Laval, Québec; Health Care Services Systems Analysis and Evaluation Directorate(Gauthier), Quebec Public Health Institute, Université du Québec à Rimouski, Rimouski; Department of Psychology (Dupuis), Université du Québec à Montréal, Montréal, Que.; Centre for Primary Health Care and Equity (Lévesque), Faculty of Medicine, University of New South Wales, Sydney, Australia; Department of Emergency Medicine (Simard-Racine), Centre de santé et de services sociaux de La Matapédia, Amqui; McGill Chair in Family and Community Medicine Research (Haggerty), St. Mary's Hospital Centre and McGill University, Montréal; Department of Family Medicine and Emergency Medicine and Knowledge Transfer and Health Technology Assessment Group, Centre hospitalier universitaire de Québec Research Centre (Légaré), Evaluative Research Unit, Université Laval, Québec, Que
| | - Jean-Marc Chauny
- Research Chair in Emergency Medicine Université Laval - Centre hospitalier affilié universitaire Hôtel-Dieu de Lévis (Layani, Fleet, Dallaire, Tounkara, Archambault, Tanguay), Lévis; Department of Family and Emergency Medicine (Fleet, Poitras, Archambault); Intensive Care Division (Archambault), Department of Anesthesiology, Université Laval, Québec; Department of Family and Emergency Medicine (Chauny), Université de Montréal, Hôpital du Sacré-Coeur de Montréal, Montréal; Department of Political Science (Ouimet), Université Laval, Québec; Health Care Services Systems Analysis and Evaluation Directorate(Gauthier), Quebec Public Health Institute, Université du Québec à Rimouski, Rimouski; Department of Psychology (Dupuis), Université du Québec à Montréal, Montréal, Que.; Centre for Primary Health Care and Equity (Lévesque), Faculty of Medicine, University of New South Wales, Sydney, Australia; Department of Emergency Medicine (Simard-Racine), Centre de santé et de services sociaux de La Matapédia, Amqui; McGill Chair in Family and Community Medicine Research (Haggerty), St. Mary's Hospital Centre and McGill University, Montréal; Department of Family Medicine and Emergency Medicine and Knowledge Transfer and Health Technology Assessment Group, Centre hospitalier universitaire de Québec Research Centre (Légaré), Evaluative Research Unit, Université Laval, Québec, Que
| | - Mathieu Ouimet
- Research Chair in Emergency Medicine Université Laval - Centre hospitalier affilié universitaire Hôtel-Dieu de Lévis (Layani, Fleet, Dallaire, Tounkara, Archambault, Tanguay), Lévis; Department of Family and Emergency Medicine (Fleet, Poitras, Archambault); Intensive Care Division (Archambault), Department of Anesthesiology, Université Laval, Québec; Department of Family and Emergency Medicine (Chauny), Université de Montréal, Hôpital du Sacré-Coeur de Montréal, Montréal; Department of Political Science (Ouimet), Université Laval, Québec; Health Care Services Systems Analysis and Evaluation Directorate(Gauthier), Quebec Public Health Institute, Université du Québec à Rimouski, Rimouski; Department of Psychology (Dupuis), Université du Québec à Montréal, Montréal, Que.; Centre for Primary Health Care and Equity (Lévesque), Faculty of Medicine, University of New South Wales, Sydney, Australia; Department of Emergency Medicine (Simard-Racine), Centre de santé et de services sociaux de La Matapédia, Amqui; McGill Chair in Family and Community Medicine Research (Haggerty), St. Mary's Hospital Centre and McGill University, Montréal; Department of Family Medicine and Emergency Medicine and Knowledge Transfer and Health Technology Assessment Group, Centre hospitalier universitaire de Québec Research Centre (Légaré), Evaluative Research Unit, Université Laval, Québec, Que
| | - Josée Gauthier
- Research Chair in Emergency Medicine Université Laval - Centre hospitalier affilié universitaire Hôtel-Dieu de Lévis (Layani, Fleet, Dallaire, Tounkara, Archambault, Tanguay), Lévis; Department of Family and Emergency Medicine (Fleet, Poitras, Archambault); Intensive Care Division (Archambault), Department of Anesthesiology, Université Laval, Québec; Department of Family and Emergency Medicine (Chauny), Université de Montréal, Hôpital du Sacré-Coeur de Montréal, Montréal; Department of Political Science (Ouimet), Université Laval, Québec; Health Care Services Systems Analysis and Evaluation Directorate(Gauthier), Quebec Public Health Institute, Université du Québec à Rimouski, Rimouski; Department of Psychology (Dupuis), Université du Québec à Montréal, Montréal, Que.; Centre for Primary Health Care and Equity (Lévesque), Faculty of Medicine, University of New South Wales, Sydney, Australia; Department of Emergency Medicine (Simard-Racine), Centre de santé et de services sociaux de La Matapédia, Amqui; McGill Chair in Family and Community Medicine Research (Haggerty), St. Mary's Hospital Centre and McGill University, Montréal; Department of Family Medicine and Emergency Medicine and Knowledge Transfer and Health Technology Assessment Group, Centre hospitalier universitaire de Québec Research Centre (Légaré), Evaluative Research Unit, Université Laval, Québec, Que
| | - Gilles Dupuis
- Research Chair in Emergency Medicine Université Laval - Centre hospitalier affilié universitaire Hôtel-Dieu de Lévis (Layani, Fleet, Dallaire, Tounkara, Archambault, Tanguay), Lévis; Department of Family and Emergency Medicine (Fleet, Poitras, Archambault); Intensive Care Division (Archambault), Department of Anesthesiology, Université Laval, Québec; Department of Family and Emergency Medicine (Chauny), Université de Montréal, Hôpital du Sacré-Coeur de Montréal, Montréal; Department of Political Science (Ouimet), Université Laval, Québec; Health Care Services Systems Analysis and Evaluation Directorate(Gauthier), Quebec Public Health Institute, Université du Québec à Rimouski, Rimouski; Department of Psychology (Dupuis), Université du Québec à Montréal, Montréal, Que.; Centre for Primary Health Care and Equity (Lévesque), Faculty of Medicine, University of New South Wales, Sydney, Australia; Department of Emergency Medicine (Simard-Racine), Centre de santé et de services sociaux de La Matapédia, Amqui; McGill Chair in Family and Community Medicine Research (Haggerty), St. Mary's Hospital Centre and McGill University, Montréal; Department of Family Medicine and Emergency Medicine and Knowledge Transfer and Health Technology Assessment Group, Centre hospitalier universitaire de Québec Research Centre (Légaré), Evaluative Research Unit, Université Laval, Québec, Que
| | - Alain Tanguay
- Research Chair in Emergency Medicine Université Laval - Centre hospitalier affilié universitaire Hôtel-Dieu de Lévis (Layani, Fleet, Dallaire, Tounkara, Archambault, Tanguay), Lévis; Department of Family and Emergency Medicine (Fleet, Poitras, Archambault); Intensive Care Division (Archambault), Department of Anesthesiology, Université Laval, Québec; Department of Family and Emergency Medicine (Chauny), Université de Montréal, Hôpital du Sacré-Coeur de Montréal, Montréal; Department of Political Science (Ouimet), Université Laval, Québec; Health Care Services Systems Analysis and Evaluation Directorate(Gauthier), Quebec Public Health Institute, Université du Québec à Rimouski, Rimouski; Department of Psychology (Dupuis), Université du Québec à Montréal, Montréal, Que.; Centre for Primary Health Care and Equity (Lévesque), Faculty of Medicine, University of New South Wales, Sydney, Australia; Department of Emergency Medicine (Simard-Racine), Centre de santé et de services sociaux de La Matapédia, Amqui; McGill Chair in Family and Community Medicine Research (Haggerty), St. Mary's Hospital Centre and McGill University, Montréal; Department of Family Medicine and Emergency Medicine and Knowledge Transfer and Health Technology Assessment Group, Centre hospitalier universitaire de Québec Research Centre (Légaré), Evaluative Research Unit, Université Laval, Québec, Que
| | - Jean-Frédéric Lévesque
- Research Chair in Emergency Medicine Université Laval - Centre hospitalier affilié universitaire Hôtel-Dieu de Lévis (Layani, Fleet, Dallaire, Tounkara, Archambault, Tanguay), Lévis; Department of Family and Emergency Medicine (Fleet, Poitras, Archambault); Intensive Care Division (Archambault), Department of Anesthesiology, Université Laval, Québec; Department of Family and Emergency Medicine (Chauny), Université de Montréal, Hôpital du Sacré-Coeur de Montréal, Montréal; Department of Political Science (Ouimet), Université Laval, Québec; Health Care Services Systems Analysis and Evaluation Directorate(Gauthier), Quebec Public Health Institute, Université du Québec à Rimouski, Rimouski; Department of Psychology (Dupuis), Université du Québec à Montréal, Montréal, Que.; Centre for Primary Health Care and Equity (Lévesque), Faculty of Medicine, University of New South Wales, Sydney, Australia; Department of Emergency Medicine (Simard-Racine), Centre de santé et de services sociaux de La Matapédia, Amqui; McGill Chair in Family and Community Medicine Research (Haggerty), St. Mary's Hospital Centre and McGill University, Montréal; Department of Family Medicine and Emergency Medicine and Knowledge Transfer and Health Technology Assessment Group, Centre hospitalier universitaire de Québec Research Centre (Légaré), Evaluative Research Unit, Université Laval, Québec, Que
| | - Geneviève Simard-Racine
- Research Chair in Emergency Medicine Université Laval - Centre hospitalier affilié universitaire Hôtel-Dieu de Lévis (Layani, Fleet, Dallaire, Tounkara, Archambault, Tanguay), Lévis; Department of Family and Emergency Medicine (Fleet, Poitras, Archambault); Intensive Care Division (Archambault), Department of Anesthesiology, Université Laval, Québec; Department of Family and Emergency Medicine (Chauny), Université de Montréal, Hôpital du Sacré-Coeur de Montréal, Montréal; Department of Political Science (Ouimet), Université Laval, Québec; Health Care Services Systems Analysis and Evaluation Directorate(Gauthier), Quebec Public Health Institute, Université du Québec à Rimouski, Rimouski; Department of Psychology (Dupuis), Université du Québec à Montréal, Montréal, Que.; Centre for Primary Health Care and Equity (Lévesque), Faculty of Medicine, University of New South Wales, Sydney, Australia; Department of Emergency Medicine (Simard-Racine), Centre de santé et de services sociaux de La Matapédia, Amqui; McGill Chair in Family and Community Medicine Research (Haggerty), St. Mary's Hospital Centre and McGill University, Montréal; Department of Family Medicine and Emergency Medicine and Knowledge Transfer and Health Technology Assessment Group, Centre hospitalier universitaire de Québec Research Centre (Légaré), Evaluative Research Unit, Université Laval, Québec, Que
| | - Jeannie Haggerty
- Research Chair in Emergency Medicine Université Laval - Centre hospitalier affilié universitaire Hôtel-Dieu de Lévis (Layani, Fleet, Dallaire, Tounkara, Archambault, Tanguay), Lévis; Department of Family and Emergency Medicine (Fleet, Poitras, Archambault); Intensive Care Division (Archambault), Department of Anesthesiology, Université Laval, Québec; Department of Family and Emergency Medicine (Chauny), Université de Montréal, Hôpital du Sacré-Coeur de Montréal, Montréal; Department of Political Science (Ouimet), Université Laval, Québec; Health Care Services Systems Analysis and Evaluation Directorate(Gauthier), Quebec Public Health Institute, Université du Québec à Rimouski, Rimouski; Department of Psychology (Dupuis), Université du Québec à Montréal, Montréal, Que.; Centre for Primary Health Care and Equity (Lévesque), Faculty of Medicine, University of New South Wales, Sydney, Australia; Department of Emergency Medicine (Simard-Racine), Centre de santé et de services sociaux de La Matapédia, Amqui; McGill Chair in Family and Community Medicine Research (Haggerty), St. Mary's Hospital Centre and McGill University, Montréal; Department of Family Medicine and Emergency Medicine and Knowledge Transfer and Health Technology Assessment Group, Centre hospitalier universitaire de Québec Research Centre (Légaré), Evaluative Research Unit, Université Laval, Québec, Que
| | - France Légaré
- Research Chair in Emergency Medicine Université Laval - Centre hospitalier affilié universitaire Hôtel-Dieu de Lévis (Layani, Fleet, Dallaire, Tounkara, Archambault, Tanguay), Lévis; Department of Family and Emergency Medicine (Fleet, Poitras, Archambault); Intensive Care Division (Archambault), Department of Anesthesiology, Université Laval, Québec; Department of Family and Emergency Medicine (Chauny), Université de Montréal, Hôpital du Sacré-Coeur de Montréal, Montréal; Department of Political Science (Ouimet), Université Laval, Québec; Health Care Services Systems Analysis and Evaluation Directorate(Gauthier), Quebec Public Health Institute, Université du Québec à Rimouski, Rimouski; Department of Psychology (Dupuis), Université du Québec à Montréal, Montréal, Que.; Centre for Primary Health Care and Equity (Lévesque), Faculty of Medicine, University of New South Wales, Sydney, Australia; Department of Emergency Medicine (Simard-Racine), Centre de santé et de services sociaux de La Matapédia, Amqui; McGill Chair in Family and Community Medicine Research (Haggerty), St. Mary's Hospital Centre and McGill University, Montréal; Department of Family Medicine and Emergency Medicine and Knowledge Transfer and Health Technology Assessment Group, Centre hospitalier universitaire de Québec Research Centre (Légaré), Evaluative Research Unit, Université Laval, Québec, Que
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Rechel B, Džakula A, Duran A, Fattore G, Edwards N, Grignon M, Haas M, Habicht T, Marchildon GP, Moreno A, Ricciardi W, Vaughan L, Smith TA. Hospitals in rural or remote areas: An exploratory review of policies in 8 high-income countries. Health Policy 2016; 120:758-69. [DOI: 10.1016/j.healthpol.2016.05.011] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2015] [Revised: 04/20/2016] [Accepted: 05/17/2016] [Indexed: 10/21/2022]
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Fleet R, Tounkara FK, Ouimet M, Dupuis G, Poitras J, Tanguay A, Fortin JP, Trottier JG, Ouellet J, Lortie G, Plant J, Morris J, Chauny JM, Lauzier F, Légaré F. Portrait of trauma care in Quebec's rural emergency departments and identification of priority intervention needs to improve the quality of care: a study protocol. BMJ Open 2016; 6:e010900. [PMID: 27098826 PMCID: PMC4838705 DOI: 10.1136/bmjopen-2015-010900] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Trauma remains the primary cause of death in individuals under 40 years of age in Canada. In Quebec, the Trauma Care Continuum (TCC) has been demonstrated to be effective in decreasing the mortality rate among trauma victims. Although rural citizens are at greater risk for trauma and trauma death, no empirical data concerning the effectiveness of the TCC for the rural population in Quebec are available. The emergency departments (EDs) are important safety nets for rural citizens. However, our data indicate that access to diagnostic support services, such as intensive care units and CT is limited in rural areas. The objectives are to (1) draw a portrait of trauma services in rural EDs; (2) explore geographical variations in trauma care in Quebec; (3) identify adaptable factors that could reduce variation; and (4) establish consensus solutions for improving the quality of care. METHODS AND ANALYSIS The study will take place from November 2015 to November 2018. A mixed methodology (qualitative and quantitative) will be used. We will include data (2009-2013) from all trauma victims treated in the 26 rural EDs and tertiary/secondary care centres in Quebec. To meet objectives 1 and 2, data will be gathered from the Ministry's Database of the Quebec Trauma Registry Information System. For objectives 3 and 4, the project will use the Delphi method to develop consensus solutions for improving the quality of trauma care in rural areas. Data will be analysed using a Poisson regression to compare mortality rate during hospital stay or death on ED arrival (objectives 1 and 2). Average scores and 95% CI will be calculated for the Delphi questionnaire (objectives 3 and 4). ETHICS AND DISSEMINATION This protocol has been approved by CSSS Alphonse-Desjardins research ethics committee (Project MP-HDL-2016-003). The results will be published in peer-reviewed journals.
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Affiliation(s)
- Richard Fleet
- Department of Family and Emergency Medicine, Université Laval, Québec, Quebec, Canada
- Research Chair in Emergency Medicine, Univerité Laval - CHAU Hôtel-Dieu de Lévis, Lévis, Quebec, Canada
| | - Fatoumata Korika Tounkara
- Research Chair in Emergency Medicine, Univerité Laval - CHAU Hôtel-Dieu de Lévis, Lévis, Quebec, Canada
| | - Mathieu Ouimet
- Department of Political Science, Université Laval, Québec, Quebec, Canada
| | - Gilles Dupuis
- Département de Psychologie, Université du Québec à Montréal, Montréal, Quebec, Canada
| | - Julien Poitras
- Department of Family and Emergency Medicine, Université Laval, Québec, Quebec, Canada
| | - Alain Tanguay
- Research Chair in Emergency Medicine, Univerité Laval - CHAU Hôtel-Dieu de Lévis, Lévis, Quebec, Canada
| | - Jean Paul Fortin
- Département de Médecine Sociale et Préventive, Université Laval, Québec, Quebec, Canada
| | - Jean-Guy Trottier
- Centre de Santé et de Services Sociaux de l'Hématite, Fermont, Quebec, Canada
| | - Jean Ouellet
- Department of Family and Emergency Medicine, Université Laval, Québec, Quebec, Canada
| | - Gilles Lortie
- Department of Family and Emergency Medicine, Université Laval, Québec, Quebec, Canada
| | - Jeff Plant
- Department of Emergency Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Judy Morris
- Hôpital du Sacré-Cœur de Montréal, Université de Montréal, Montréal, Quebec, Canada
| | - Jean Marc Chauny
- Hôpital du Sacré-Cœur de Montréal, Université de Montréal, Montréal, Quebec, Canada
| | - François Lauzier
- CHU de Québec and Université Laval, Research center, Quebec, Quebec, Canada
| | - France Légaré
- Department of Family Medicine and Emergency Medicine, Knowledge Transfer and Health Technology Assessment of the CHUQ Research Centre (CRCHUQ), Unité de Recherche Évaluative, Université Laval, Québec, Quebec, Canada
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