为印度部分地区的急救系统开发一个以患者为中心的高质量综合模型：一项实施研究方案（印度急救医疗服务研究）

Developing a high-quality patient-centric integrated model for emergency care system in selected districts of India: An implementation research protocol (INDIA-EMS Study).

作者信息

Ayyan S Manu, Kumar Singh Arvind, S Patadia Hemantkumar, Patel Shreyas, Saigal Saurabh, Durai Pandian Jeyaraj, Varghese Thejus, Joshi Ankur, Sharma Meenakshi

机构信息

Department of Emergency Medicine & Trauma, Jawaharlal Institute of Post Graduate Medical Education and Research (JIPMER), Puducherry, India.

Department of Community & Family Medicine, All India Institute of Medical Sciences (AIIMS), Bhubaneswar, Odisha, India.

出版信息

PLoS One. 2025 Sep 3;20(9):e0331290. doi: 10.1371/journal.pone.0331290. eCollection 2025.

DOI:10.1371/journal.pone.0331290

PMID:40901771

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12407451/

Abstract

INTRODUCTION

Integrated emergency care systems are essential for achieving universal health coverage and managing time-sensitive conditions. In India, emergency care remains fragmented, with limited resources and coordination across healthcare tiers. The INDIA-EMS study aims to develop and evaluate a patient-centric, high-quality integrated emergency care model in diverse Indian districts.

METHODOLOGY

The proposed implementation research is designed as a mixed methods study to be conducted over a 3-year period in selected districts of the states of Punjab, Gujarat, Madhya Pradesh, Odisha and Puducherry. The public/private medical college hospital/ tertiary care hospital in the district will serve as a hub and primary health care services as spokes. The health facilities will be graded according to the availability of resources for their readiness and preparedness to provide care for handling a particular emergency condition. The steps to build and implement the model are: 1. a gap analysis related to emergency care at both pre-hospital and health facility level; 2. a community-based survey in a sample of 30,000 in 5 districts for EMD burden estimates and health-seeking behaviour at baseline and endline; 3. use a consolidated framework for implementation research to develop, optimise and implement hub and spoke model through three cycles of iterative processes; and; 4.evaluation for feasibility, acceptability, cost, effectiveness and coverage.

DISCUSSION

A high-quality patient-centric integrated emergency care model may be able to ensure efficient delivery of care to patients experiencing time-sensitive emergencies and advance towards the coveted target under Sustainable Development Goals (SDGs).

ETHICS AND DISSEMINATION

Ethics approval was obtained in all the project sites. The results of the project will be submitted to a peer-reviewed journal for publication, in addition to national and state-level dissemination.

TRIAL REGISTRATION

The trial is registered with CTRI (Clinical Trial Registry of India; CTRI/2024/01/061304).

摘要

引言

综合急救系统对于实现全民健康覆盖和管理时间敏感型病症至关重要。在印度，急救护理仍然分散，各医疗层级之间资源有限且缺乏协调。印度紧急医疗服务（INDIA-EMS）研究旨在在印度不同地区开发并评估一种以患者为中心的高质量综合急救模式。

方法

拟开展的实施研究设计为一项混合方法研究，将在旁遮普邦、古吉拉特邦、中央邦、奥里萨邦和本地治里联合属地的选定地区进行，为期3年。各地区的公立/私立医学院附属医院/三级护理医院将作为中心，初级卫生保健服务机构作为分支。卫生设施将根据其为应对特定紧急情况而提供护理的准备情况和资源可用性进行分级。构建和实施该模式的步骤如下：1. 对院前和卫生设施层面的急救护理进行差距分析；2. 在5个地区对30000名样本进行基于社区的调查，以估计基线和终线时的急救医疗需求负担及就医行为；3. 使用实施研究的综合框架，通过三个迭代过程循环来开发、优化和实施中心-分支模式；4. 对可行性、可接受性、成本、有效性和覆盖范围进行评估。