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.
BACKGROUND
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
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).


BACKGROUND
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.
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.
Richard
R
Fleet
Research Chair in Emergency Medicine, Univerité Laval - CHAU Hôtel-Dieu de Lévis, Lévis, Quebec, Canada.
Fatoumata Korika
FK
Tounkara
Department of Political Science, Université Laval, Québec, Quebec, Canada.
Mathieu
M
Ouimet
Département de Psychologie, Université du Québec à Montréal, Montréal, Quebec, Canada.
Gilles
G
Dupuis
Department of Family and Emergency Medicine, Université Laval, Québec, Quebec, Canada.
Julien
J
Poitras
Research Chair in Emergency Medicine, Univerité Laval - CHAU Hôtel-Dieu de Lévis, Lévis, Quebec, Canada.
Alain
A
Tanguay
Département de Médecine Sociale et Préventive, Université Laval, Québec, Quebec, Canada.
Jean Paul
JP
Fortin
Centre de Santé et de Services Sociaux de l'Hématite, Fermont, Quebec, Canada.
Jean-Guy
JG
Trottier
Department of Family and Emergency Medicine, Université Laval, Québec, Quebec, Canada.
Jean
J
Ouellet
Department of Family and Emergency Medicine, Université Laval, Québec, Quebec, Canada.
Gilles
G
Lortie
Department of Emergency Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
Jeff
J
Plant
Hôpital du Sacré-Cœur de Montréal, Université de Montréal, Montréal, Quebec, Canada.
Judy
J
Morris
Hôpital du Sacré-Cœur de Montréal, Université de Montréal, Montréal, Quebec, Canada.
Jean Marc
JM
Chauny
CHU de Québec and Université Laval, Research center, Quebec, Quebec, Canada.
François
F
Lauzier
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.
France
F
Légaré
D000328:Adult; D002648:Child; D004632:Emergency Medical Services / Q000592:standards*; D004636:Emergency Service, Hospital; D006292:Health Priorities; D006297:Health Services Accessibility; D006301:Health Services Needs and Demand; D006801:Humans; D011787:Quality of Health Care; D011792:Quebec; D019035:Rural Health Services / Q000592:standards*; D012424:Rural Population
Inequalities; Quebec; Trauma Care Continuum; Trauma care; rural emergency departments