Implementing surgical services in a rural, resource-limited setting

A study protocol

Duncan Smith Rohrberg Maru, Ryan Schwarz, Dan Schwarz, Jason Andrews, Maria Theresa Panizales, Gregory Karelas, Jesse Stark Brady, Selwyn Rogers

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

Introduction: There are well-established protocols and procedures for the majority of common surgical diseases, yet surgical services remain largely inaccessible for much of the world's rural poor. Data on the process and outcome of surgical care expansion, however, are very limited, and the roll-out process of rural surgical implementation in particular has never been studied. Here, we propose the first implementation research study to assess the surgical scale-up process in the rural district of Achham, Nepal. Methods and analysis: Based primarily on the protocols of the WHO's Integrated Management for Emergency and Essential Surgical Care (IMEESC), this study's threefold implementation strategy will include: (1) the core IMEESC surgical care program, (2) community-based follow-up via health workers, and (3) hospital-based quality improvement programs. The implementation program will employ additional emergency and surgical care protocols developed collaboratively by physicians, nurses and the authors. This strategy will be referred to as IMEESC-Plus. This study will employ both qualitative and quantitative research methodologies to collect clinical data and information on the reception and utilisation of services. The first 18 months of the implementation process will be studied and divided into an initial phase (first 6 months) and a consolidation phase (subsequent 12 months). Discussion: This study aims to describe the logistics of the implementation process of IMEESC-Plus, and assess the quality of the resulting IMEESC-Plus services during the course of the implementation process. Using data generated from this study, larger, multi-site implementation studies can be planned that assess the scale-up of surgical services worldwide in resource-limited areas.

Original languageEnglish (US)
Article number000166
JournalBMJ Open
Volume1
Issue number1
DOIs
StatePublished - 2011
Externally publishedYes

Fingerprint

Emergencies
Nepal
Qualitative Research
Emergency Medical Services
Quality Improvement
Research Design
Nurses
Physicians
Health
Research

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Maru, D. S. R., Schwarz, R., Schwarz, D., Andrews, J., Panizales, M. T., Karelas, G., ... Rogers, S. (2011). Implementing surgical services in a rural, resource-limited setting: A study protocol. BMJ Open, 1(1), [000166]. https://doi.org/10.1136/bmjopen-2011-000166

Implementing surgical services in a rural, resource-limited setting : A study protocol. / Maru, Duncan Smith Rohrberg; Schwarz, Ryan; Schwarz, Dan; Andrews, Jason; Panizales, Maria Theresa; Karelas, Gregory; Brady, Jesse Stark; Rogers, Selwyn.

In: BMJ Open, Vol. 1, No. 1, 000166, 2011.

Research output: Contribution to journalArticle

Maru, DSR, Schwarz, R, Schwarz, D, Andrews, J, Panizales, MT, Karelas, G, Brady, JS & Rogers, S 2011, 'Implementing surgical services in a rural, resource-limited setting: A study protocol', BMJ Open, vol. 1, no. 1, 000166. https://doi.org/10.1136/bmjopen-2011-000166
Maru DSR, Schwarz R, Schwarz D, Andrews J, Panizales MT, Karelas G et al. Implementing surgical services in a rural, resource-limited setting: A study protocol. BMJ Open. 2011;1(1). 000166. https://doi.org/10.1136/bmjopen-2011-000166
Maru, Duncan Smith Rohrberg ; Schwarz, Ryan ; Schwarz, Dan ; Andrews, Jason ; Panizales, Maria Theresa ; Karelas, Gregory ; Brady, Jesse Stark ; Rogers, Selwyn. / Implementing surgical services in a rural, resource-limited setting : A study protocol. In: BMJ Open. 2011 ; Vol. 1, No. 1.
@article{a952913c0444452dbcf84348456a08b6,
title = "Implementing surgical services in a rural, resource-limited setting: A study protocol",
abstract = "Introduction: There are well-established protocols and procedures for the majority of common surgical diseases, yet surgical services remain largely inaccessible for much of the world's rural poor. Data on the process and outcome of surgical care expansion, however, are very limited, and the roll-out process of rural surgical implementation in particular has never been studied. Here, we propose the first implementation research study to assess the surgical scale-up process in the rural district of Achham, Nepal. Methods and analysis: Based primarily on the protocols of the WHO's Integrated Management for Emergency and Essential Surgical Care (IMEESC), this study's threefold implementation strategy will include: (1) the core IMEESC surgical care program, (2) community-based follow-up via health workers, and (3) hospital-based quality improvement programs. The implementation program will employ additional emergency and surgical care protocols developed collaboratively by physicians, nurses and the authors. This strategy will be referred to as IMEESC-Plus. This study will employ both qualitative and quantitative research methodologies to collect clinical data and information on the reception and utilisation of services. The first 18 months of the implementation process will be studied and divided into an initial phase (first 6 months) and a consolidation phase (subsequent 12 months). Discussion: This study aims to describe the logistics of the implementation process of IMEESC-Plus, and assess the quality of the resulting IMEESC-Plus services during the course of the implementation process. Using data generated from this study, larger, multi-site implementation studies can be planned that assess the scale-up of surgical services worldwide in resource-limited areas.",
author = "Maru, {Duncan Smith Rohrberg} and Ryan Schwarz and Dan Schwarz and Jason Andrews and Panizales, {Maria Theresa} and Gregory Karelas and Brady, {Jesse Stark} and Selwyn Rogers",
year = "2011",
doi = "10.1136/bmjopen-2011-000166",
language = "English (US)",
volume = "1",
journal = "BMJ Open",
issn = "2044-6055",
publisher = "BMJ Publishing Group",
number = "1",

}

TY - JOUR

T1 - Implementing surgical services in a rural, resource-limited setting

T2 - A study protocol

AU - Maru, Duncan Smith Rohrberg

AU - Schwarz, Ryan

AU - Schwarz, Dan

AU - Andrews, Jason

AU - Panizales, Maria Theresa

AU - Karelas, Gregory

AU - Brady, Jesse Stark

AU - Rogers, Selwyn

PY - 2011

Y1 - 2011

N2 - Introduction: There are well-established protocols and procedures for the majority of common surgical diseases, yet surgical services remain largely inaccessible for much of the world's rural poor. Data on the process and outcome of surgical care expansion, however, are very limited, and the roll-out process of rural surgical implementation in particular has never been studied. Here, we propose the first implementation research study to assess the surgical scale-up process in the rural district of Achham, Nepal. Methods and analysis: Based primarily on the protocols of the WHO's Integrated Management for Emergency and Essential Surgical Care (IMEESC), this study's threefold implementation strategy will include: (1) the core IMEESC surgical care program, (2) community-based follow-up via health workers, and (3) hospital-based quality improvement programs. The implementation program will employ additional emergency and surgical care protocols developed collaboratively by physicians, nurses and the authors. This strategy will be referred to as IMEESC-Plus. This study will employ both qualitative and quantitative research methodologies to collect clinical data and information on the reception and utilisation of services. The first 18 months of the implementation process will be studied and divided into an initial phase (first 6 months) and a consolidation phase (subsequent 12 months). Discussion: This study aims to describe the logistics of the implementation process of IMEESC-Plus, and assess the quality of the resulting IMEESC-Plus services during the course of the implementation process. Using data generated from this study, larger, multi-site implementation studies can be planned that assess the scale-up of surgical services worldwide in resource-limited areas.

AB - Introduction: There are well-established protocols and procedures for the majority of common surgical diseases, yet surgical services remain largely inaccessible for much of the world's rural poor. Data on the process and outcome of surgical care expansion, however, are very limited, and the roll-out process of rural surgical implementation in particular has never been studied. Here, we propose the first implementation research study to assess the surgical scale-up process in the rural district of Achham, Nepal. Methods and analysis: Based primarily on the protocols of the WHO's Integrated Management for Emergency and Essential Surgical Care (IMEESC), this study's threefold implementation strategy will include: (1) the core IMEESC surgical care program, (2) community-based follow-up via health workers, and (3) hospital-based quality improvement programs. The implementation program will employ additional emergency and surgical care protocols developed collaboratively by physicians, nurses and the authors. This strategy will be referred to as IMEESC-Plus. This study will employ both qualitative and quantitative research methodologies to collect clinical data and information on the reception and utilisation of services. The first 18 months of the implementation process will be studied and divided into an initial phase (first 6 months) and a consolidation phase (subsequent 12 months). Discussion: This study aims to describe the logistics of the implementation process of IMEESC-Plus, and assess the quality of the resulting IMEESC-Plus services during the course of the implementation process. Using data generated from this study, larger, multi-site implementation studies can be planned that assess the scale-up of surgical services worldwide in resource-limited areas.

UR - http://www.scopus.com/inward/record.url?scp=84860412692&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84860412692&partnerID=8YFLogxK

U2 - 10.1136/bmjopen-2011-000166

DO - 10.1136/bmjopen-2011-000166

M3 - Article

VL - 1

JO - BMJ Open

JF - BMJ Open

SN - 2044-6055

IS - 1

M1 - 000166

ER -