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Healthcare Research QI Support Intake Form
Name of primary contact for this project:
Position/Department:
Campus Mailing Address:
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Phone (306-xxx-xxxx)
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If you are not the Principal Investigator/Supervisor (i.e. faculty member) for this project, please provide the supervisor's name and department:
Do you have the ethics approval for this study?
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Pending
Stage of research:
Design (No data yet)
Analysis (Data collected)
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Results likely will be published as:
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Is this project related to a degree or course requirements:
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Is this project quality improvement focus research? (i.e. directly aims to improve patient outocmes, improve the quality of healthcare services):
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Please provide a brief description of the quality improvement focus of your research (Quality metrics including accessibility, effectiveness, efficiency, patient-centred, safe, timely, equity)
Give a brief description of the scientific background and the specific aims of the study. What data is to be used to achieve these aims?
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Give a brief description of the data (if any) you have collected:
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