Swansea University Medical School, Swansea University, Swansea, Wales, UK
Swansea University Medical School, Swansea University, Swansea, Wales, UK.
BMJ Open. 2022 Mar 29;12(3):e053123. doi: 10.1136/bmjopen-2021-053123.
UK ambulance services have identified a concern with high users of the 999 service and have set up 'frequent callers' services, ranging from within-service management to cross-sectoral multidisciplinary case management approaches. There is little evidence about how to address the needs of this patient group.
To evaluate effectiveness, safety and efficiency of case management approaches to the care of people who frequently call the emergency ambulance service, and gain an understanding of barriers and facilitators to implementation.
(1) Develop an understanding of predicted mechanisms of change to underpin evaluation. (2) Describe epidemiology of sustained high users of 999 services. (3) Evaluate case management approaches to the care of people who call the 999 ambulance service frequently in terms of: (i) Further emergency contacts (999, emergency department, emergency admissions to hospital) (ii) Effects on other services (iii) Adverse events (deaths, injuries, serious medical emergencies and police arrests) (iv) Costs of intervention and care (v) Patient experience of care. (4) Identify challenges and opportunities associated with using case management models, including features associated with success, and develop theories about how case management works in this population.
We will conduct a multisite mixed-methods evaluation of case management for people who use ambulance services frequently by using anonymised linked routine data outcomes in a 'natural experiment' cohort design, in four regional ambulance services. We will conduct interviews and focus groups with service users, commissioners and emergency and non-acute care providers. The planned start and end dates of the study are 1 April 2019 and 1 September 2022, respectively ETHICS AND DISSEMINATION: The study received approval from the UK Health Research Authority (Confidentiality Advisory Group reference number: 19/CAG/0195; research ethics committee reference number: 19/WA/0216).We will collate feedback from our Lived Experience Advisory Panel, the Frequent Caller National Network and Research Management Group for targeted dissemination activities.
英国的救护车服务机构已经注意到，999 服务的高频用户数量过多，并设立了“高频呼叫者”服务，服务范围从内部服务管理到跨部门多学科病例管理方法。目前几乎没有关于如何满足这一患者群体需求的证据。
评估针对频繁拨打紧急救护车服务的患者的病例管理方法的有效性、安全性和效率，并了解实施过程中的障碍和促进因素。
（1）了解支持评估的预测机制变化。（2）描述持续大量使用 999 服务的患者的流行病学特征。（3）评估针对高频拨打 999 救护车服务的患者的病例管理方法，具体包括：（i）进一步的紧急联系（999、急诊部、急诊入院）；（ii）对其他服务的影响；（iii）不良事件（死亡、伤害、严重医疗紧急情况和警察逮捕）；（iv）干预和护理成本；（v）患者对护理的体验。（4）识别与使用病例管理模式相关的挑战和机遇，包括与成功相关的特征，并制定关于病例管理在该人群中如何运作的理论。
我们将通过在四个地区的救护车服务中使用匿名链接的常规数据结果，在“自然实验”队列设计中，对高频使用救护车服务的患者进行多站点混合方法评估。我们将对服务使用者、专员以及紧急和非急性护理提供者进行访谈和焦点小组讨论。该研究的计划开始和结束日期分别为 2019 年 4 月 1 日和 2022 年 9 月 1 日。
该研究获得了英国健康研究局的批准（保密性咨询小组编号：19/CAG/0195；研究伦理委员会编号：19/WA/0216）。我们将汇总来自我们的生活体验咨询小组、高频呼叫者国家网络和研究管理小组的反馈，以便进行有针对性的传播活动。
