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Implementation and Evaluation of a Wiki Involving Multiple Stakeholders Including Patients in the Promotion of Best Practices in Trauma Care: The WikiTrauma Interrupted Time Series Protocol

QC-PA-WikiTrauma and Trama Care

Quebec (ED)

Background: Trauma is the most   common cause of mortality among people between the ages of 1 and 45 years,   costing Canadians 19.8 billion dollars a year (2004 data), yet half of all   patients with major traumatic injuries do not receive evidence-based care,   and significant regional variation in the quality of care across Canada exists. Accordingly, our goal is to lead a research project in which   stakeholders themselves will adapt evidence-based trauma care knowledge tools   to their own varied institutional contexts and cultures. We will do this by   developing and assessing the combined impact of WikiTrauma, a free   collaborative database of clinical decision support tools, and Wiki101, a   training course teaching participants how to use WikiTrauma. WikiTrauma has   the potential to ensure that all stakeholders (eg, patients, clinicians, and   decision makers) can all contribute to, and benefit from, evidence-based   clinical knowledge about trauma care that is tailored to their own needs and   clinical setting. 

Objective: Our main objective will be to study the combined effect of   WikiTrauma and Wiki101 on the quality of care in four trauma centers in   Quebec. Methods: First,   we will pilot-test the wiki with potential users to create a version ready to   test in practice. A rapid, iterative prototyping process with 15 health   professionals from nonparticipating centers will allow us to identify and   resolve usability issues prior to finalizing the definitive version for the   interrupted time series. Second, we will conduct an interrupted time series   to measure the impact of our combined intervention on the quality of care in   four trauma centers that will be selected-one level I, one level II, and two   level III centers. Participants will be health care professionals working in   the selected trauma centers. Also, five patient representatives will be   recruited to participate in the creation of knowledge tools destined for their   use (eg, handouts). All participants will be invited to complete the Wiki101   training and then use, and contribute to, WikiTrauma for 12 months. The   primary outcome will be the change over time of a validated, composite,   performance indicator score based on 15 process performance indicators found   in the Quebec Trauma Registry. 

Results: This project was funded in November 2014 by the Canadian   Medical Protective Association. We expect to start this trial in early 2015   and preliminary results should be available in June 2016. Two trauma centers   have already agreed to participate and two more will be recruited in the next   months. 

Conclusions: We   expect that this study will add important and unique evidence about the   effectiveness, safety, and cost savings of using collaborative platforms to   adapt knowledge implementation tools across jurisdictions.

Authors: Patrick M Archambault, Alexis F Turgeon, Holly O Witteman, François Lauzier, Lynne Moore, François Lamontagne, Tanya Horsley, Marie-Pierre Gagnon, Arnaud Droit, Matthew Weiss, Sébastien Tremblay, Jean Lachaine, Natalie Le Sage, Marcel Émond, Simon Berthelot, Ariane Plaisance, Jean Lapointe, Tarek Razek, Tom H van de Belt, Kevin Brand, Mélanie Bérubé, Julien Clément, Francisco Jose Grajales Iii, Gunther Eysenbach, Craig Kuziemsky, Debbie Friedman, Eddy Lang, John Muscedere, Sandro Rizoli, Derek J Roberts, Damon C Scales, Tasnim Sinuff, Henry T Stelfox, Isabelle Gagnon, Christian Chabot, Richard Grenier, France Légaré, Canadian Critical Care Trials Group

Patrick M. Archebault -

Planning / Thinking Stage

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