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      Harnessing inter-disciplinary collaboration to improve emergency care in low- and middle-income countries (LMICs): results of research prioritisation setting exercise

      research-article
      1 , 2 , 1 , 2 , 1 , 1 , 3 , 4 , 5 , 6 , 4 , 4 , 1 , 1 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 1 , 22 , 23 , 24 , 25 , 26 , 27 ,
      BMC Emergency Medicine
      BioMed Central
      Global Health, Research prioritisation, Quality indicators, Emergency care systems, Low resource settings

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          Abstract

          Background

          More than half of deaths in low- and middle-income countries (LMICs) result from conditions that could be treated with emergency care - an integral component of universal health coverage (UHC) - through timely access to lifesaving interventions.

          Methods

          The World Health Organization (WHO) aims to extend UHC to a further 1 billion people by 2023, yet evidence supporting improved emergency care coverage is lacking. In this article, we explore four phases of a research prioritisation setting (RPS) exercise conducted by researchers and stakeholders from South Africa, Egypt, Nepal, Jamaica, Tanzania, Trinidad and Tobago, Tunisia, Colombia, Ethiopia, Iran, Jordan, Malaysia, South Korea and Phillipines, USA and UK as a key step in gathering evidence required by policy makers and practitioners for the strengthening of emergency care systems in limited-resource settings.

          Results

          The RPS proposed seven priority research questions addressing: identification of context-relevant emergency care indicators, barriers to effective emergency care; accuracy and impact of triage tools; potential quality improvement via registries; characteristics of people seeking emergency care; best practices for staff training and retention; and cost effectiveness of critical care – all within LMICs.

          Conclusions

          Convened by WHO and facilitated by the University of Sheffield, the Global Emergency Care Research Network project (GEM-CARN) brought together a coalition of 16 countries to identify research priorities for strengthening emergency care in LMICs. Our article further assesses the quality of the RPS exercise and reviews the current evidence supporting the identified priorities.

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          Most cited references4

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          Defining quality indicators for emergency care delivery: findings of an expert consensus process by emergency care practitioners in Africa

          Facility-based emergency care delivery in low-income and middle- income countries is expanding rapidly, particularly in Africa. Unfortunately, these efforts rarely include measurement of the quality or the impact of care provided, which is essential for improvement of care provision. Our aim was to determine context-appropriate quality indicators that will allow uniform and objective data collection to enhance emergency care delivery throughout Africa. We undertook a multiphase expert consensus process to identify, rank and refine quality indicators. A comprehensive review of the literature identified existing indicators; those associated with a substantial burden of disease in Africa were categorised and presented to consensus conference delegates. Participants selected indicators based on inclusion criteria and priority clinical conditions. The indicators were then presented to a group of expert clinicians via on-line survey; all meeting agreements were refined in-person by a separate panel and ranked according to validity, feasibility and value. The consensus working group selected seven conditions addressing nearly 75% of mortality in the African region to prioritise during indicator development, and the final product at the end of the multiphase study was a list of 76 indicators. This comprehensive process produced a robust set of quality indicators for emergency care that are appropriate for use in the African setting. The adaptation of a standardised set of indicators will enhance the quality of care provided and allow for comparison of system strengthening efforts and resource distribution.
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            Advancing research on emergency care systems in low-income and middle-income countries: ensuring high-quality care delivery systems

            Emergency care systems (ECS) address a wide range of acute conditions, including emergent conditions from communicable diseases, non-communicable diseases, pregnancy and injury. Together, ECS represent an area of great potential for reducing morbidity and mortality in low-income and middle-income countries (LMICs). It is estimated that up to 54% of annual deaths in LMICs could be addressed by improved prehospital and facility-based emergency care. Research is needed to identify strategies for enhancing ECS to optimise prevention and treatment of conditions presenting in this context, yet significant gaps persist in defining critical research questions for ECS studies in LMICs. The Collaborative on Enhancing Emergency Care Research in LMICs seeks to promote research that improves immediate and long-term outcomes for clients and populations with emergent conditions. The objective of this paper is to describe systems approaches and research strategies for ECS in LMICs, elucidate priority research questions and methodology, and present a selection of studies addressing the operational, implementation, policy and health systems domains of health systems research as an approach to studying ECS. Finally, we briefly discuss limitations and the next steps in developing ECS-oriented interventions and research.
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              Clinical emergency care research in low-income and middle-income countries: opportunities and challenges

              Disease processes that frequently require emergency care constitute approximately 50% of the total disease burden in low-income and middle-income countries (LMICs). Many LMICs continue to deal with emergencies caused by communicable disease states such as pneumonia, diarrhoea, malaria and meningitis, while also experiencing a marked increase in non-communicable diseases, such as cardiovascular diseases, diabetes mellitus and trauma. For many of these states, emergency care interventions have been developed through research in high-income countries (HICs) and advances in care have been achieved. However, in LMICs, clinical research, especially interventional trials, in emergency care are rare. Furthermore, there exists minimal research on the emergency management of diseases, which are rarely encountered in HICs but impact the majority of LMIC populations. This paper explores challenges in conducting clinical research in patients with emergency conditions in LMICs, identifies examples of successful clinical research and highlights the system, individual and study design characteristics that made such research possible in LMICs. Derived from the available literature, a focused list of high impact research considerations are put forth.
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                Author and article information

                Contributors
                lee.wallis@uct.ac.za
                Journal
                BMC Emerg Med
                BMC Emerg Med
                BMC Emergency Medicine
                BioMed Central (London )
                1471-227X
                31 August 2020
                31 August 2020
                2020
                : 20
                : 68
                Affiliations
                [1 ]GRID grid.11835.3e, ISNI 0000 0004 1936 9262, School of Health and Related Research, , University of Sheffield, Sheffield, and Emergency Deparment, Salford Royal Hospital, ; Salford, UK
                [2 ]GRID grid.3575.4, ISNI 0000000121633745, World Health Organisation, ; Geneva, Switzerland
                [3 ]GRID grid.416099.3, ISNI 0000 0001 2218 112X, Scarborough General Hospital, ; Tobago, Canada
                [4 ]GRID grid.12916.3d, ISNI 0000 0001 2322 4996, The University of West Indies, ; Kingston, Jamaica
                [5 ]GRID grid.11956.3a, ISNI 0000 0001 2214 904X, Divsion of Emergency Medicine, , Stellenbosch University, ; Cape Town, South Africa
                [6 ]GRID grid.266102.1, ISNI 0000 0001 2297 6811, University of California San Francisco, ; San Francisco, USA
                [7 ]Manmohan Memorial Institute of Health Sciences, Kathmandu, Nepal
                [8 ]Emergency Medical Services for the Western Cape Government, Cape Town, South Africa
                [9 ]Emergency Medical Association of Tanzania (EMAT), Dar es Salaam, Tanzania
                [10 ]GRID grid.25867.3e, ISNI 0000 0001 1481 7466, Muhimbili University of Health and Allied Science, ; Dar es Salaam, Tanzania
                [11 ]GRID grid.7269.a, ISNI 0000 0004 0621 1570, Ain Shams University, ; Cairo, Egypt
                [12 ]GRID grid.416246.3, Muhimbili National Hospital, ; Dar es Salaam, Tanzania
                [13 ]GRID grid.412195.a, ISNI 0000 0004 1761 4447, Neurosciences Institute, , El Bosque University, ; Bogotá, Colombia
                [14 ]Colombian Trauma Association, Bogotá, Colombia
                [15 ]Ministry of Health, Bab Saadoun, Tunisia
                [16 ]GRID grid.412484.f, ISNI 0000 0001 0302 820X, Seoul National University Hospital, ; Seoul, South Korea
                [17 ]GRID grid.427645.6, ISNI 0000 0004 0393 8328, American Heart Association (AHA), ; Dallas, USA
                [18 ]Ministry of Health, Tehran, Iran
                [19 ]GRID grid.21729.3f, ISNI 0000000419368729, Columbia University, , Emergency Medicine, ; New York, NY USA
                [20 ]GRID grid.414835.f, Ministry of Health, ; Addis Ababa, Ethiopia
                [21 ]American Heart Association (AHA), Geneva, Switzerland
                [22 ]Philippine College of Emergency Medicine, Parañaque, Philippines
                [23 ]GRID grid.452474.4, ISNI 0000 0004 1759 7907, Sungai Buloh Hospital, ; Sungai Buloh, Malaysia
                [24 ]GRID grid.413123.6, ISNI 0000 0004 0455 9733, Bugando Medical Centre, ; Mwanza, Tanzania
                [25 ]GRID grid.415773.3, Ministry of Health, ; Amman, Jordan
                [26 ]GRID grid.59062.38, ISNI 0000 0004 1936 7689, Divsion of Emergency Medicine, , University of Vermont, ; Burlington, Vermont USA
                [27 ]GRID grid.7836.a, ISNI 0000 0004 1937 1151, Division of Emergency Medicine, , University of Cape Town, ; F51 Old Main Building, Groote Schuur Hospital Observatory, Cape Town, South Africa
                Author information
                http://orcid.org/0000-0003-2711-3139
                Article
                362
                10.1186/s12873-020-00362-7
                7457362
                32867675
                17cbe511-9af5-423c-a1eb-d4ef2fa1e3cb
                © The Author(s) 2020

                Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

                History
                : 30 July 2020
                : 19 August 2020
                Funding
                Funded by: UK Global Challege Research Fund
                Award ID: X/159905
                Categories
                Research Article
                Custom metadata
                © The Author(s) 2020

                Emergency medicine & Trauma
                global health,research prioritisation,quality indicators,emergency care systems,low resource settings

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