EQUIP Emergency: Study protocol for an organizational intervention to promote equity in health care.
Open accessAbstract
BACKGROUND: Social inequities are widening globally, contributing to growing health and health care inequities. Health inequities are unjust differences in health and well-being between and within groups of people caused by socially structured, and thus avoidable, marginalizing conditions such as poverty and systemic racism. In Canada, such conditions disproportionately affect Indigenous persons, racialized newcomers, those with mental health and substance use issues, and those experiencing interpersonal violence. Despite calls to enhance equity in health care to contribute to improving population health, few studies examine how to achieve equity at the point of care, and the impacts of doing so. Many people facing marginalizing conditions experience inadequate and inequitable treatment in emergency departments (EDs), which makes people less likely to access care, paradoxically resulting in reliance on EDs through delays to care and repeat visits, interfering with effective care delivery and increasing human and financial costs. EDs are key settings with potential for mitigating the impacts of structural conditions and barriers to care linked to health inequities. METHODS: EQUIP is an organizational intervention to promote equity. Building on promising research in primary health care, we are adapting EQUIP to emergency departments, and testing its impact at three geographically and demographically diverse EDs in one Canadian province. A mixed methods multisite design will examine changes in key outcomes including: a) a longitudinal analysis of change over time based on structured assessments of patients and staff, b) an interrupted time series design of administrative data (i.e., staff sick leave, patients who leave without care being completed), c) a process evaluation to assess how the intervention was implemented and the contextual features of the environment and process that are influential for successful implementation, and d) a cost-benefit analysis. DISCUSSION: This project will generate both process- and outcome-based evidence to improve the provision of equity-oriented health care in emergency departments, particularly targeting groups known to be at greatest risk for experiencing the negative impacts of health and health care inequities. The main deliverable is a health equity-enhancing framework, including implementable, measurable interventions, tested, refined and relevant to diverse EDs. TRIAL REGISTRATION: Clinical Trials.gov # NCT03369678 (registration date November 18, 2017).
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Ratings of quality of care in the SMH sample were high, with an average of 8.11 (SD 2.14) on a 0-10 scale.
“ratings of quality of care in our sample were high, with an average of 8.11 (SD 2.14) on a scale of 0–10, as measured by an item from the British Columbia Emergency Department Patient Experiences of Care scale [10, 24, 36, 77].”
From Using a health equity lens to measure patient experiences of care in diverse health care settings (2024) · cites this paper as [36]
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Self-citation
- Authors
- Varcoe, C., Bungay, V., Browne, A. J., Wilson, E., Wathen, C. N., Kolar, K., Perrin, N., Comber, S., Blanchet Garneau, A., Byres, D., Black, A., & Price, E. R.
- Affiliations
- University of British Columbia (CA)
- University of Northern British Columbia (CA)
- Western University (CA)
- Johns Hopkins University (US)
- Dalhousie University (CA)
- Ministry of Health (CA)
- Providence Health Care (CA)
- Corresponding author
- Varcoe, Colleen
- ORCID
- Venue
- BMC Health Services Research
- Published
- 2019-10-10
- Volume
- 19
- Issue
- 1
- Pages
- 687-687
- ISSN
- 1472-6963 (ISSN-L)
- PMC
- PMC6785893
- OpenAlex
- W2980191504
- Cited by
- 47
- References
- 50
- Citations by year
- 2026: 5 · 2025: 5 · 2024: 6 · 2023: 4 · 2022: 8 · 2021: 12 · 2020: 7
- FWCI
- 7.84
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Locations
- BMC Health Services Research (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- cIRcle (University of British Columbia) (submittedVersion, cc-by)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
- Scholarship@Western (Western University) (submittedVersion)
- Open Collections
- Funders
- Canadian Institutes of Health Research (PJT148832)
- Topics
- Health Sciences › Medicine › Emergency Medicine › Emergency and Acute Care Studies
- Social Sciences › Sociology and Political Science › Cultural Competency in Health Care
- Social Sciences › Health › Health disparities and outcomes
- Keywords
- health equity, emergency department, organizational interventions, EQUIP, health care inequities, social determinants of health, indigenous peoples, mental health, substance use, interpersonal violence, implementation evaluation, cost-benefit analysis, health equity frameworks
- MeSH terms
- Clinical Studies as Topic, Health Equity, British Columbia, Clinical Protocols, Delivery of Health Care, Emergency Service, Hospital, Humans, Indians, North American, Mental Health Services, Primary Health Care, Violence, Substance-Related Disorders, Health Status Disparities, Healthcare Disparities, Racism, Interrupted Time Series Analysis
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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