Modularity and Complexity in Global Trauma System Development

创伤正在成为新的全球大流行。在全世界每年约500万人的所有死亡中，约有10%是由创伤引起的，其中90%发生在低收入和中等收入国家。为了解决这一问题，许多高收入国家(HIC)已经实施了自己的创伤系统，但这些系统的设计往往不能转移到需求更大的LMIC环境中。创伤系统应该被视为高度集成、相互依赖和复杂的系统，因此，如果系统的其他领域仍然不是最优的或失败的，那么对系统单个组件的改进不太可能反映在明显的临床结果改善中。创伤护理可以被视为系统问题的顶峰，因为它包括复杂和异质的患者群体和疾病表现，需要协调的宏观医疗保健和微观临床系统，涉及多种和可变的结果衡量标准。该项目旨在回答如何通过系统工程方法最好地在LMIC中设计、开发和维护创伤系统。使用混合方法，我们将首先了解LMICs在创伤提供方面的现状和主要利益相关者，然后评估专注于创伤护理组成部分的每个方面所涉及的机会-成本和风险。到项目结束时，我们的目标是开发一种新的方法方法，通过这种方法，可以在资源有限的情况下实施和优化创伤系统。

Trauma is emerging as the new global pandemic. Around 10% of all deaths that occur worldwide, approximately 5 million people each year, are due to trauma, with 90% of these injury-related deaths occurring in low- and middle- income countries (LMICs). To tackle this problem, many High Income Countries (HICs) have implemented their own trauma systems, however the design of these are often non-transferable to the LMIC setting, where the need is even greater. Trauma systems should be viewed as highly integrated, interdependent, and complex systems, therefore improvement to a single component of the system is unlikely to be reflected in demonstrably improved clinical outcomes, if other areas of the system remain sub-optimal or failing. Trauma care can be viewed as the pinnacle of a systems problem, as it comprises complex and heterogenous patient groups and disease presentations, and requires co-ordinated macro-healthcare and micro-clinical systems, with multiple and variable outcome measures involved. This project aims to answer how trauma systems can best be designed, developed, and maintained in LMICs through a systems engineering approach. Using mixed methods we will first understand the current landscape and key stakeholders in trauma provision in LMICs, before assessing opportunity-costs and risks involved in focussing on each aspect of the trauma care components. By the end of the project, we aim to develop a new methodological approach through which a trauma system can be implemented and optimised within a resource- limited setting.