Capstone research projects database
The Capstone research project is where students work on real-world issues.
See the Capstone projects TRP students have worked on over the years.
UC-ON
UC-ON is a multi-site data collaborative focused on clinics that serve uninsured and undocumented patients across Ontario. The goal is pretty simple: right now, these clinics are doing critical work, but the data is fragmented and often not usable across sites. We’re building a standardized, de-identified dataset so we can describe service use patterns, patient needs, barriers to access, and resource intensity — and ultimately support better planning and stronger funding advocacy with real evidence.
Background
Ontario’s healthcare system is frequently characterized as universal; however, a substantial and poorly measured population remains excluded from consistent access to publicly funded care. Existing literature suggests that between 200,000 and 500,000 people in Ontario alone are medically uninsured at any given time, largely due to immigration-related barriers, including undocumented status, expired or precarious immigration status, temporary resident categories, and mandatory waiting periods for provincial coverage such as the Ontario Health Insurance Plan (OHIP) (Garasia et al., 2023).
The gaps within this space are not theoretical. For example, the OHIP three-month waiting period (which was temporarily lifted during the COVID-19 pandemic) historically left many newcomers without coverage during their initial settlement period, contributing to delayed or forgone care (Niraula et al., 2023). Contrary to being often described as universal, this dynamic creates a de facto uninsured population that relies on a patchwork of services, including community health centres (CHCs), dedicated uninsured walk-in clinics, volunteer-run clinics, and informal referral networks (Health Network for Uninsured Clients, n.d.).
Despite the critical role these clinics play, there is a striking lack of Canadian, Ontario-specific quantitative literature that systematically describes who these patients are, what care they receive, the barriers they face, and the resources required to meet demand. A recent systematic review of evidence on uninsured migrant populations in Canada identified only 10 quantitative studies, and importantly, no quantitative research capturing economic costs associated with uninsured care (Garasia et al., 2023). Existing work is often qualitative, geographically limited, or aggregated in ways that obscure operational realities at the clinic level. Even foundational estimates of the uninsured population are broad and imprecise, reflecting substantial measurement challenges rather than definitive counts (Garasia et al., 2023).
The absence of robust data is resulting in concrete consequences where both patients and the Canadian healthcare system are suffering. Clinics serving uninsured and undocumented populations frequently operate with limited resources, variable funding streams, and chronic demand-capacity mismatches, yet they lack the empirical evidence needed to justify staffing models, service structures, or stable funding. Clinics, funders and policymakers, in turn, lack data that quantifies unmet need, service utilization patterns, and resource intensity, making it difficult to design targeted investments, system-level supports, or efficient workflow maps that could improve access and outcomes (Health Network for Uninsured Clients, n.d.).
This project aims to respond directly to the gap in the literature through the creation of a multi-clinic, standardized, de-identified dataset drawn from clinics already providing care to uninsured and undocumented patients across the GTA and Ontario. By leveraging existing partnerships and routinely collected clinical data, this project will generate actionable evidence that supports:
- More efficient and equitable resource allocation within clinics
- Stronger funding and policy advocacy grounded in real service utilization data
- A foundational empirical literature base for uninsured care in Ontario
Project team
- Ayyah Elayan
- Rukana Ragutharan
TRP supervisors
See our community directory for more on committee members.
Understanding Peer Support Needs of Adolescents and Young Adults with Cancer in Pediatrics
This project explores how to design meaningful peer support for adolescents and young adults (AYA) with cancer, evolving from an initial idea into a translational, mixed-methods approach grounded in stakeholder input and system understanding.
Background
This project started with three colleagues in the same program who had an idea – to help teens with cancer in pediatrics. We had very different backgrounds and experiences; one geriatrician with subspecialty training in cognitive neurology, one mental health research project manager with experience transitioning youth from pediatric to adult mental health services, and one pediatric hematologist/oncologist with an interest in AYA oncology. The idea was born after a brainstorming session in which we discussed the results of an informal needs assessment study previously conducted at SickKids. Our initial plan was to design a solution to help teens with cancer connect to each other. The early phases of our project involved brainstorming ideas for solutions, and we were quite focused on social media as a platform and designing a physical space or “teen lounge”. However, from learning about translational research, we realized that: A) we needed to better understand this problem space and the needs of our population, and B) that we were jumping to solutions without actually knowing what patients want. From the literature, we also learned about the vastness of peer support possibilities. The initial informal interviews conducted did not contain nearly enough information or data on which to base our project, as it was too broad and not adequate to properly understand a specific patient need. We went back to the drawing board. We decided to focus on one area that was a suspected need based on the literature, first-hand experience, an environmental scan of existing programs, and trends from the results of the informal needs assessment. Our goal had evolved – to connect teens with cancer to each other: peer support for AYA in pediatrics. As academic clinicians, scientific rigor was important to us; however, we are grateful for the constant reminders that conducting a single-component scientific study is unlikely to provide sufficient information on which to base a successful patient intervention. Brainstorming the design of the mixed methods study came rather naturally to us, and this was initially our entire plan. However, the Translational ThinkingTM Framework introduced to us at the Translational Research Program (TRP) stresses the importance of understanding the current landscape by speaking to a wide variety of stakeholders, which we realized would be critical to ensure future success. We learned that there are several obstacles and required steps before an idea can become a solution and before that solution can be successfully implemented and sustained. Hence, we developed the two-component translational approach and decided to informally explore the perceived value of peer support among key stakeholders in AYA oncology in parallel to the formal study. In addition, we came to realize the importance of knowledge translation (KT) in the process of ultimately implementing a successful and sustainable intervention. Of course the process of this project did not go as we anticipated; many people we met along the way helped to guide us, and our project, in various directions. Each step of the way, we re-grouped, made decisions, changed our plans, and learned about flexibility, ambiguity, and health care system, and research intricacies. We have learned more than we ever thought possible.
Project team
- Philippe Desmarais
- Katye Stevens
- Danielle Weidman
TRP supervisors
Project advisory committee
- Abha Gupta, MD, Sick Kids;
- Jackie Bender, MSc, PhD, UHN research;
- Christopher Klinger, PhD, University of Toronto
- Heather Colquhoun, PhD, OT Reg, University of Toronto
See our community directory for more on committee members.
UNITE: Understanding the needs and desires of primary stakeholders in long-term dementia care
The UNITE study amplifies the voices of long-term care residents with cognitive impairment in Toronto, revealing key structural and relational factors that shape their quality of life and offering insights for sector-wide improvement.
Background
The UNITE study uniquely features the voices of PWDs living in LTC in Toronto, Ontario. Semi-structured interviews with residents of Kensington Gardens, as well as loved ones of residents, and subsequent descriptive data analysis revealed aspects of care that impact the residents’ quality of life. Residents of Kensington Gardens who are living with mild to moderate cognitive impairment value meaningful engagement in activities that they enjoy, such as playing games, listening to music and going outside, as well as those which make them feel useful. Having a sense of purpose and autonomy are desired, but not always achievable in the context of LTC. This, along with the discomfort of dealing with the symptoms of their peers and/or themselves, can lead to a dissonance between their current and former or desired lives. Resultingly, residents may experience feelings of sadness, apathy, loneliness, and/or frustration. This perceptual dichotomy can currently be combatted through maintaining a daily routine, having consistent care providers, and cultivating friendships with staff and other residents. Residents appreciate receiving care from staff who can anticipate their needs and relate to them on a personal level. Ultimately, residents appreciate a LTC home that is centred on the comfort and enjoyment of its residents; is bright, clean, and offers private personal space; and which offers personalized care from staff who are not rushed. Loved ones mirrored the sentiments of residents, also identifying the importance of communication between staff and adapting supports and activities for varied levels of impairment. A synthesis of interview findings within the context of Donabedian’s framework for healthcare quality indicates whether factors that influence resident quality of life are structural or process-oriented in nature. Additionally, a comparison of study findings to the home’s most recent satisfaction survey identified priority areas that contribute to QoL not captured through the survey: (1) access to meaningful activities that make residents feel useful, (2) support in coping with group living while dealing with the cognitive decline of self and others, and (3) substantial friendships between residents and staff as well as residents. Kensington Gardens can use the findings of this study to prioritize quality improvement initiatives. The information may also be useful to other stakeholders in the sector, such as the Ministry of Long-Term Care, as they work to build LTC services that meet the needs and desires of residents and their families.
Project team
- Katherine Tucker
TRP supervisors
Project advisory committee
- Andrea Austen
- Vinita Haroun
- Lisa Cranley
See our community directory for more on committee members.
Voices in Transition
Criminalized women in Canada face significant health disparities, particularly in oral care. Many enter prison with pre-existing dental issues linked to poverty, homelessness, and substance use. In custody, care is limited to emergency treatments, leaving chronic conditions unaddressed. Upon release, women encounter barriers such as missing ID, stigma, low employment, and limited healthcare access. These challenges worsen oral health and hinder reintegration. Addressing these gaps requires leveraging existing community resources to build sustainable pathways to dental care. A community-based, equity-focused approach is essential to improving health outcomes and supporting successful reintegration for formerly incarcerated women.
Background
Formerly incarcerated women in Ontario face significant barriers to dental care, including lack of insurance, low income, no valid ID, and stigma. In prison, oral health is often neglected, leading to worsening conditions. Post-release, basic needs take priority, pushing dental care aside and resulting in chronic pain, poor nutrition, and mental health issues—obstacles to employment and reintegration. This project aims to assess and implement a sustainable dental care initiative, starting with a needs assessment. A model will connect community clinics and nonprofits to offer free or subsidized care. Outcomes will be evaluated to ensure effectiveness, scalability, and long-term impact.
Project team
TRP supervisors
See our community directory for more on committee members.
Waiting for Help: Wait Times at the Centre for Addictions and Mental Health Bridging Clinic
This QI project at CAMH’s Bridging Clinic explores interventions to improve client satisfaction with wait times and reduce prolonged waits in a drop-in mental health model.
Background
In healthcare, wait times are a complex issue that has negative impacts on both client and staff (2–4). The Bridging Clinic at the Centre for Addiction and Mental Health (CAMH) utilizes a first-come, first-serve drop-in model to provide clients with low barrier access to mental health services. One consequence of this type of service delivery model is prolonged wait times. Data from the Bridging Clinic monthly service report (October 2020 to March 2021) indicates that, on average, 47% of clients wait longer than one hour from the time of registration to the initial clinician assessment. The authors conducted a current state analysis to determine the impact of prolonged wait times. This included a review of client comments from the results of the 2018 and 2019 Ontario Perceptions of Care Tool from CAMH (n=64), which found that out of 31 negative comments, 41.9% indicated that clients are dissatisfied with the wait times at the Bridging Clinic. The amount of time spent waiting can directly affect client satisfaction, additionally the clients’ experience while waiting and not the actual time spent waiting can also affect their overall satisfaction (5,6). Reducing the actual wait time in a first-come-first-serve drop-in clinic model is challenging as the demand cannot always be matched to the service capacity. There is a need to improve clients' satisfaction with waiting by improving the waiting experience or decreasing the actual amount of time spent waiting.
Given these factors, there were two aim statements set for this project:
1. To improve the average daily rating of the client waiting experience by 1 point on a 7- point Likert scale by June 30, 2021.
This project adds value by using QI principles to explore the waiting experience and explore client satisfaction with waiting as another dimension of the problem. The project is working towards achieving the primary aim of improving client satisfaction with the waiting experience. Thus far, the data has highlighted areas for improvement and led to the design of a low-fidelity prototype whiteboard to provide clients with more information about their wait to improve the waiting experience. The project team will continue working towards the aim statements until project completion, anticipated to be June 2021. The intervention will be implemented, evaluated, and iterated using a series of PDSA cycles. The project team has received tremendous support from the Bridging Clinic staff and stakeholders to continue the implementation and evaluation phase of the project. To achieve a sustainable change, the goal is to use the current intervention to build a case for the clinic to receive funding for an electronic intervention. To ensure the success of this intervention, it must become the new way of working, rather than something added on top of routine clinical care. This project used several sustainability tools. Firstly, the team has communicated with all Bridging Clinic staff and leadership regarding the improvement plan. The project team regularly interacts with staff via email and attends staff meetings, staff huddles, and occasionally, the Bridging Clinic Senior Leadership meetings. To support a culture of improvement, collect staff feedback, and anticipate challenges, it is important to keep consistent contact with the primary users of the intervention. In addition, the project team has created a written "How to" guide outlining the step-by-step instructions, with visuals, for using the intervention. This guide includes explaining each task, who is responsible for which task, at what time each task is to be completed. This process ensures consistency for all client encounters and all staff members regardless of their role at the clinic. Overall, the project has collected sufficient data to move forward with the intervention, but further study is required throughout the implementation and evaluation phases. Upon completion of the remaining phases, the project team will report the findings in the capstone defense at the beginning of July 2021. Following the capstone defense, the project team will present the findings to the Bridging Clinic. Contingent on the final evaluation of the low-fidelity prototype, the future of the project may include a high-fidelity version of the intervention and develop strategies to sustain the intervention. The team also plans to prepare a manuscript for publication.
2. To reduce the number of clients that wait greater than one hour from registration to first clinician assessment by 25% by June 30, 2021.
Project team
- Maame Darkwa
- Katrina Engel
- Zoe Findlay
- Anne-Marie Voyer
TRP supervisors
Project advisory committee
- Christine Shea
- Olivier St. Cyr
- Grace Collins
- Donna Alexander
See our community directory for more on committee members.
What’s in a name: Improving familiarity and trust in dynamic interprofessional operating room teams
This study explores how name familiarity among operating room team members improves communication, trust, and teamwork, and identifies interventions to enhance these connections.
Background
Healthcare is delivered in teams. Quality healthcare depends on teamwork and communications between individuals in a team. The operating room (OR) is a challenging place for teamwork because people work dynamically with uncertain schedule changes and variable team members. Teams are also wearing masks, gowns and caps, which makes it hard to recognize who is in the room. To improve teamwork, introducing each person by their name and role was suggested. We were interested in understanding how knowing the names of team members impacted how they work together. We wanted to examine current interventions and innovations that support name familiarity in the OR. Methods
We interviewed nurses, anesthesiologists, anesthesia assistants and surgeons in an academic hospital. To analyze our data, we applied definitions of Trust (Confidence in systems, Swift Trust based on a role, Individuated Trust based on a specific person) to understand our results and created a framework for describing how people experience names and familiarity in the OR team. Based on participants’ experiences of familiarity and trust, we summarized the needs and values of OR team members to identify interventions and implementation strategies to address current gaps. Results
The use of names helped people to communicate directly and more efficiently. In the long run, names helped people to remember each other and how to work well together by establishing trust between individuals. Names also impacted how people felt about teamwork including feelings of belonging, respect and humanity, which created trust in the team. A total of 35 interventions were identified and analyzed including novel ideas that could be further developed. Current interventions are effective for establishing Swift Trust. Team members preferred interpersonal communications and appreciated individual efforts to adapt to unfamiliarity. Conclusions
Names in dynamic teams were perceived to be more effective for team communications while also providing a foundation to build trust between team members. Although current interventions enable team function, longterm trust and changes in the attitudes and culture of the OR may improve the team environment.
Project team
- Tobi Lam
TRP supervisors
Project advisory committee
- Jacob Hirsh
- Melanie Hammond Mobilio
- Dean Lising
See our community directory for more on committee members.