The Communicate Study Partnership

Study Overview
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Brief Summary
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The vision of the Communicate Study Partnership is to ensure more Aboriginal patients receive culturally safe healthcare in their first language. The Communicate Study Partnership will implement and evaluate creative ways to embed cultural safety training and increase use of Aboriginal Interpreters and Aboriginal Health Practitioners at Northern Territory Top End hospitals. Quantitative outcomes (interpreter uptake, outcomes including leave against medical advice, costs) will be measured using time-series analysis. Qualitative outcomes derived from interviews with patient, healthcare provider and interpreter participants, will be informed by decolonising theory and participatory approaches. Successful project implementation will improve experience of care and health outcomes for Aboriginal people, build Aboriginal workforce, and improve healthcare provider satisfaction.

Detailed Description
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The goal of The Communicate Study: partnership across the Top End to improve Aboriginal patients' experience and outcomes of healthcare is to achieve sustainable organisational change to provide excellence in cultural and clinical safety for Aboriginal people utilising NT Health facilities. Aim 1: Transform the culture of healthcare systems to achieve excellence in providing culturally safe care for First Nations peoples - Develop, implement and evaluate anti-racism training using 'Ask the specialist-Plus'. This comprises moderated discussion and reflection on 'Ask the Specialist' podcast episodes held during in-service and clinical teaching timeslots for healthcare providers Aim 2: Strengthen the tools and strategies required underpinning culturally safe practice Improve demand for Aboriginal interpreters and Aboriginal health practitioners through improved cultural understanding and recognition of patient needs Improve supply of interpreters and Aboriginal health practitioners willing to work in the hospital environment by creating a culturally safe workplace and supporting career pathways Effectiveness strategies tailored to participating sites such as positioning interpreters at points of need and embedding them in medical and surgical teams Optimising workflow to facilitate efficiency and availability across hospital departments Aim 3: Evaluate outcomes using comprehensive qualitative and quantitative measures Qualitative enquiry to assess cultural safety from patient perspectives, and understand experiences of Aboriginal and Non-Aboriginal healthcare providers and interpreters Quantitative outcomes including performance across key indicators: changes in documentation of language; Interpreter bookings made; Interpreter bookings completed; % Aboriginal patients in need getting access to an interpreter Impact of intervention: proportion of admissions with and without interpreters ending in self-discharge; unplanned re-admissions and changes in hospital length of stay economic analysis of the costs and cost benefits of interpreter use to decrease self-discharge and re-admission rates.

Official Title
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The Communicate Study Partnership - Improving Healthcare Experiences and Outcomes for Aboriginal Peoples Through Delivery of Culturally Safe Healthcare in First Languages

Conditions
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Aboriginal Health, Cultural Safety, Access to Interpreters, Healthcare Provider Training

Intervention / Treatment
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* Behavioral: Interventions to transform the culture of healthcare systems to achieve excellence in providing culturally safe care for First Nations peoples


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Different patient and provider participants (e.g. Aboriginal patients, Aboriginal interpreters, healthcare providers of any ethnicity) will be invited to participate in interviews, observations and surveys to assess effectiveness of study activities Exclusion Criteria: None
Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Health Services Research
Intervention Model: Single Group Assignment
Interventional Model Description: Interventions to transform the culture of healthcare systems to achieve excellence in providing culturally safe care for First Nations peoples
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Cultural safety training and behaviour change intervention<br>- Interventions to transform the culture of healthcare systems to achieve excellence in providing culturally safe care for First Nations peoples | Behavioral: Interventions to transform the culture of healthcare systems to achieve excellence in providing culturally safe care for First Nations peoples<br>* Implement 'Ask the Specialist Plus', a structured program to promote anti-racism within Northern Territory (NT) hospitals by giving healthcare providers training in cultural safety. Implement strategies to foster 'Clinical champions of cultural safety' through a social media chat platform and face to face meetings to discuss anti-racism practice, cultural safety and practical ways to deliver culturally safe care including interpreter use. Support simplified and improved strategies for booking an interpreter to increase uptake. Implement retention strategies to ensure interpreters receive workplace support. Provide training in health terminology for interpreters. Integrate interpreter supply and demand through efficiency and effectiveness strategies tailored to participating sites. Implement continuous quality improvement cycles with senior managers, using findings from qualitative and quantitative data collection and evaluation.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Self discharge among Aboriginal inpatients at Royal Darwin Hospital, Palmerston Hospital, Katherine Hospital and Gove District Hospital | Self discharge (also referred to as 'Discharge against medical advice,', 'take own leave' or 'incomplete care') will be assessed among all admitted Aboriginal patients every quarter as a measure of the effeciveness of hospital-level study activities Measured as proportion of all admissions of Aboriginal people that end in self-discharge Data source: hospital Admitted Patient Care dataset (routinely collected by health services) The study has a two-year baseline phase July 1 2020 - June 30 2022, and four-year intervention (activity) period July 1 2022 - June 30 2026. There are no individually enrolled participants followed up at given time points; instead, activities are implemented continually at the level of the health systems, and outcomes are assessed using continuous hospital data and qualitative data, summarised quarterly. | Up to 4 years. (Health system level data are collected and summarised quarterly during July 1 2022 - June 30 2026, and compared with the baseline phase July 1 2020 - June 30 2022) | 
| Patient experience (qualitative evaluation) | Patient experience pre- and post-implementation of the interventions will be assessed through in-depth 30-60 minute one-on-one, face-to-face interviews of inpatients and patients who have recently (within 14 days) been discharged, by a member of the research team. The research team member will speak the patient's first language, or will work with an Aboriginal interpreter to conduct the interview. Some individuals with repeated contact with healthservices (such as renal dialysis patients) will be invited to participate in serial interviews over time | Up to 4 years. Interview data will be collected at regular intervals throughout the study (2022-2026) to track any change in patient experience during the course of the intervention period | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Documentation of language in hospital medical records | Adequacy of documentation (proportion of Aboriginal patients for whom language is documented) will be used to inform quarterly quality improvement data review meetings. Data source: hospital electronic system (currently CARESYS, transitioning during the study period to ACACIA) | Up to 4 years. (Documentation of language will be tracked throughout the 4-year intervention period.) | 
| Access to an interpreter during admission | Interpreter access (proportion of Aboriginal patients with a language other than English as their first language) will be used to inform quarterly quality improvement data review meetings. | Up to 4 years. (Documentation of interpreter access will be tracked throughout the 4-year intervention period.) | 
| Healthcare provider experience | Healthcare provider experience of working with Aboriginal interpreters (qualitative evaluation) assessed by 30 minute semi-structured one-on-one, face-to-face interviews of healthcare providers with a member of the research team. | Up to 4 years. Interview data will be collected at regular intervals throughout the study (2022-2026) to track any change in healthcare provider experience during the course of the intervention period | 
| Cost | Healthcare costs will be calculated based on variables including the top 6 ICD codes per admission and hospital length of stay. Economic evaluation will be conducted from the payer perspective and include the linked Admitted Patient Care and Aboriginal Interpreter Service datasets and NTHTE Unit expenditure reports, as well as ICD codes and Australian Refined DRGs. | Up to 4 years. Continuous data (daily data, summarised monthly) will be assessed during - the two-year baseline phase July 1 2020 - June 30 2022 - the four-year intervention (activity) period July 1 2022 - June 30 2026 | 
| Unplanned readmission within 28 days | Continuous data collated monthly | Up to 4 years. Continuous data (daily data, summarised monthly) will be assessed during - the two-year baseline phase July 1 2020 - June 30 2022 - the four-year intervention (activity) period July 1 2022 - June 30 2026 |