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利用创新型电子通信平台(912卢旺达)改善卢旺达受伤人员的院前转运:一项2型混合效果-实施中断时间序列研究方案

Use of an innovative electronic communications platform (912Rwanda) to improve prehospital transport of injured people in Rwanda: protocol for a type 2 hybrid effectiveness-implementation interrupted time series study.

出版信息

BMJ Open. 2025 Aug 13;15(8):e100826. doi: 10.1136/bmjopen-2025-100826.

Abstract

INTRODUCTION

Injury is a major cause of death in Rwanda, with many deaths occurring before hospital admission. Timely transport of injured patients to appropriate hospitals is crucial, ideally within an hour for severely injured patients. However, delays in reaching treatment facilities are common, with ambulance services using inefficient mobile phone communication. This project aims to evaluate the effectiveness and implementation of an innovative electronic communication platform (912Rwanda).

METHODS AND ANALYSIS

The study will be conducted through the public ambulance service, Service d'Aide Médicale d'Urgence (SAMU), and receiving health facilities in Kigali city and Musanze district in Rwanda. The 912Rwanda intervention will be rolled out in the two locations at different times. The primary effectiveness outcome is the time from ambulance deployment to patient arrival at the health facility. Secondary effectiveness outcomes include disaggregated times of the primary outcome and clinical outcomes, such as length of stay and requirement for intensive care. These outcomes will be evaluated using an interrupted time series analysis, accounting for non-homogeneous variances, auto-regressive errors and non-linear trends where appropriate. Implementation outcomes will be evaluated using the Reach, Effectiveness, Adoption, Implementation, Maintenance (RE-AIM) Qualitative Evaluation for Systematic Translation (QuEST) framework. Cost-effectiveness will be evaluated using a cost-consequence analysis with consequences as determined by the interrupted time series analysis.

ETHICS AND DISSEMINATION

Ethical approval was obtained from the Rwanda National Research Ethics Committee (Ref No: 99/RNEC/2023). Dissemination will occur through open-access peer-reviewed publications, relevant national and international conferences.

TRIAL REGISTRATION NUMBER

ISRCTN97674565.

摘要

引言

在卢旺达,伤害是主要死因之一,许多人在入院前死亡。及时将受伤患者转运至合适的医院至关重要,对于重伤患者,理想情况下应在一小时内送达。然而,到达治疗机构的延误很常见,救护车服务使用效率低下的移动电话通信。本项目旨在评估创新电子通信平台(912卢旺达)的有效性和实施情况。

方法与分析

该研究将通过卢旺达基加利市和穆桑泽区的公共救护车服务机构——紧急医疗救助服务(SAMU)以及接收患者的医疗机构开展。912卢旺达干预措施将在两个地点不同时间推出。主要有效性指标是从救护车出动到患者抵达医疗机构的时间。次要有效性指标包括主要指标的细分时间以及临床指标,如住院时间和重症监护需求。这些指标将使用中断时间序列分析进行评估,并在适当情况下考虑非齐次方差、自回归误差和非线性趋势。实施情况将使用“覆盖范围、有效性、采用率、实施情况、维持情况(RE-AIM)系统翻译定性评估(QuEST)”框架进行评估。成本效益将使用成本后果分析进行评估,后果由中断时间序列分析确定。

伦理与传播

已获得卢旺达国家研究伦理委员会的伦理批准(参考编号:99/RNEC/2023)。传播将通过开放获取的同行评审出版物、相关的国家和国际会议进行。

试验注册号

ISRCTN97674565。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/eb10/12352135/2307f0fc01e1/bmjopen-15-8-g001.jpg

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