Promoting Health Equity for Indigenous and Non-Indigenous People in Emergency Departments
试验速览
- 阶段
- 不适用
- 状态
- 已完成
- 入组人数
- 5,439
- 试验地点
- 3
- 主要终点
- Change from baseline in patients' overall rating of care post-intervention
研究概览
简要总结
Emergency Departments (EDs) in Canada often operate over-capacity and are under significant pressures. In this environment, particular groups of people experience inadequate and inequitable treatment in EDs, including Indigenous people, racialized newcomers, people with mental illnesses, those living in unstable housing or facing homelessness, experiencing interpersonal violence or using substances, and people involved in sex work. Stigma and discrimination in health care deter people from accessing care, interfering with effective care delivery, increasing reliance on EDs, and increasing human and financial costs. This project will develop and test a framework for health equity interventions to promote the provision of equity-oriented care in EDs.
详细描述
This study examines the feasibility, process, and impacts of implementing an evidence-informed framework for interventions to enhance the capacity of Emergency Departments to provide high-quality care to people at greatest risk of experiencing health and health care inequities. The framework integrates evidence-based strategies to mitigate discrimination and racism experienced by Indigenous people, and stigma and discrimination faced by people of all ethnicities related to substance use, housing instability, sex work, gender, or mental illnesses. The study tests organizational interventions that incorporate principles of equity-oriented care, trauma- and violence-informed care, harm reduction, and cultural safety to optimize care first for Indigenous people, and then for a range of people who commonly face stigma and discrimination.
Approaching EDs as complex adaptive systems, the study aims to:
- Engage EDs in a participatory process to enhance capacity for equity-oriented care
- Examine impacts of equity-oriented interventions on processes of care, patient experiences of care and short-term outcomes, staff attitudes, confidence, behaviours and job satisfaction, and cost
- Analyze the cost-effectiveness and feasibility of implementing the interventions and scale-up potential in other contexts.
This mixed-methods study incorporates administrative data, survey data with standardized tools, in-depth interviews, analysis of policy and organizational structures, and observational data. The study is divided into multiple phases of data collection. This phase focuses on surveys of ED staff members and patients. The structured surveys use standardized tools and measures, and aim to capture staff and patients' experiences of ED care. Surveys will be conducted at three to four timepoints.
PATIENT SURVEYS will draw on patient self-reports to measure changes over time in processes of care and perceived quality of care. These indicators will be measured through structured, researcher-facilitated surveys conducted with a sample of 250-300 patients at each site at up to four points in time, providing pre- and post-intervention comparisons.
研究设计
- 研究类型
- Observational
- 观察模型
- Case Only
- 时间视角
- Cross Sectional
入排标准
- 年龄范围
- 16 Years 至 —（Child, Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 是
入选标准
- •PATIENT SURVEYS
- •Age 19 or over, or emancipated youth (16-19 years old)*
- •Able to provide informed consent.
- •Patient presenting for care at a participating ED site when survey recruitment is being conducted * Patients between age 16 and 19 will only be included if they no longer live with a parent or guardian.
- •STAFF SURVEYS
- •Age 19 or over
- •Able to understand, read and write in English
- •Staff member or health professional working in a participating ED site
排除标准
- •Individuals not meeting the inclusion criteria listed above will be excluded from participation.
结局指标
主要结局
Change from baseline in patients' overall rating of care post-intervention
时间窗: Pre-intervention: baseline & 6-9 months; Post-intervention: immediately following intervention period (14-15 months post-baseline #2)
Change in self-reported rating of care, measured on a scale from 0 to 10, comparing pre-intervention to post-intervention
Change from baseline in patients' overall rating of care at 6-11 months post-intervention
时间窗: Pre-intervention: baseline & 6-9 months; Post-intervention: 6-11 months after intervention period (21-25 months post-baseline #2)
Change in self-reported rating of care, measured on a scale from 0 to 10, comparing pre-intervention to post-intervention
Change from baseline in staff perception of patient care at 17 months post-intervention
时间窗: 29 months post-baseline
Change in staff members' self-reported perception of the patient care provided by their work unit/team, comparing pre-intervention to post-intervention
Change from baseline in staff perception of patient care post-intervention
时间窗: Immediately following intervention period (12 months post-baseline)
Change in staff members' self-reported perception of the patient care provided by their work unit/team, comparing pre-intervention to post-intervention
Change from baseline in staff perception of patient care at 6-12 months post-intervention
时间窗: 18-25 months post-baseline
Change in staff members' self-reported perception of the patient care provided by their work unit/team, comparing pre-intervention to post-intervention
次要结局
- Change from baseline in staff satisfaction and engagement at 17 months post-intervention(29 months post-baseline)
- Change from baseline in Discrimination in Medical Settings Scale post-intervention(Pre-intervention: baseline & 6-9 months; Post-intervention: immediately following intervention period (at 14 - 15 months post-baseline #2))
- Change from baseline in Discrimination in Medical Settings Scale at 6-11 months post-intervention(Pre-intervention: baseline & 6-9 months; Post-intervention: 6-11 months after intervention period (21-25 months post-baseline #2))
- Change from baseline in staff satisfaction and engagement post-intervention(Immediately following intervention period (12 months post-baseline))
- Change from baseline in staff satisfaction and engagement at 6-12 months post-intervention(18-25 months post-baseline)
研究者
Colleen Varcoe
Professor
University of British Columbia