{
  "abstract": "Introduction Urgent and emergency care in Germany is delivered across multiple, loosely connected sectors. In the absence of coherent, time-resolved data on patient movements between emergency medical services (EMS), out-of-hours ambulatory care, emergency departments (EDs) and inpatient care, inefficiencies and coordination gaps remain difficult to quantify. A process-centric, trans-sectoral analysis is required to characterise real-world patient pathways and identify actionable levers for improvement. The study aims to reconstruct, model and analyse patient pathways for urgent health complaints across all relevant sectors of the healthcare system in a German model region.Methods and analysis We will employ a mixed-methods observational study design. Routine data from EMS, out-of-hours ambulatory care, EDs and subsequent inpatient care will be pseudonymised at source, linked via a trusted third party and analysed within a trusted research environment. Time-stamped event logs will support process mining for discovery, conformance and performance analysis alongside descriptive statistics with stratification by context, such as setting, time of day, urgency and patient cohorts. Anonymous cross-sectional surveys of patients and front-line professionals, complemented by quarterly snapshot surveys in out-of-hours ambulatory care and interviews, will provide convergent evidence on the motives, barriers and coordination of utilisation behaviour. Enrolment for surveys is anticipated from the fourth quarter of 2025; routine data capture covers 1 January–31 December 2026; analyses and dissemination run until 31 December 2027.Ethics and dissemination The study received ethical approval from the Ethics Committee of the Medical Faculty at RWTH Aachen University (EK 25-351). Survey modules are conducted anonymously with voluntary participation and without collection of direct identifiers; routine care data are processed in pseudonymised form and analysed within a trusted research environment. Stakeholder interviews will be conducted with informed consent. Results will be disseminated through peer-reviewed publications, conference presentations and summary reports for participating institutions and stakeholders, complemented by plain-language materials to support patient-centred navigation.Trial registration number DRKS00035916.",
  "authors": [
    {
      "affiliations": [
        "Institute of Medical Informatics, RWTH Aachen University Medical Faculty, Aachen, Germany"
      ],
      "name": "Jonas Bienzeisler"
    },
    {
      "affiliations": [
        "Centre for Clinical Acute and Emergency Medicine, University Hospital Aachen, Aachen, Germany"
      ],
      "name": "Miriam Katharina Hertwig"
    },
    {
      "affiliations": [
        "Institute of Medical Informatics, RWTH Aachen University Medical Faculty, Aachen, Germany"
      ],
      "name": "Hauke Heidemeyer"
    },
    {
      "affiliations": [
        "Institute of Medical Informatics, RWTH Aachen University Medical Faculty, Aachen, Germany"
      ],
      "name": "Mohamed Alhaskir"
    },
    {
      "affiliations": [
        "Institute of Medical Informatics, RWTH Aachen University Medical Faculty, Aachen, Germany",
        "Department of Internal Medicine, German Center for Lung Research (DZL), Universities of Giessen and Marburg Lung Center, Giessen, Germany"
      ],
      "name": "Raphael W Majeed"
    },
    {
      "affiliations": [
        "Institute of Medical Informatics, RWTH Aachen University Medical Faculty, Aachen, Germany"
      ],
      "name": "Alexander Kombeiz"
    },
    {
      "affiliations": [
        "Institute of Medical Informatics, RWTH Aachen University Medical Faculty, Aachen, Germany"
      ],
      "name": "Wiliam Hoy"
    },
    {
      "affiliations": [
        "Institute of Medical Informatics, RWTH Aachen University Medical Faculty, Aachen, Germany"
      ],
      "name": "Simon Huening"
    },
    {
      "affiliations": [
        "Centre for Clinical Acute and Emergency Medicine, University Hospital Aachen, Aachen, Germany"
      ],
      "name": "Franziska Goettgens"
    },
    {
      "affiliations": [
        "Centre for Clinical Acute and Emergency Medicine, University Hospital Aachen, Aachen, Germany",
        "Department of Anaesthesiology, University Hospital Aachen, Aachen, Germany"
      ],
      "name": "Jenny Unterkofler"
    },
    {
      "affiliations": [
        "Centre for Clinical Acute and Emergency Medicine, University Hospital Aachen, Aachen, Germany"
      ],
      "name": "Susanne Rademacher"
    },
    {
      "affiliations": [
        "Aachen Institute for Rescue Management & Public Safety (ARS), Aachen City Fire Department, Aachen, Germany"
      ],
      "name": "Despina Panagiotidis"
    },
    {
      "affiliations": [
        "Aachen Institute for Rescue Management & Public Safety (ARS), Aachen City Fire Department, Aachen, Germany"
      ],
      "name": "Viktoria Marewski"
    },
    {
      "affiliations": [
        "Aachen Institute for Rescue Management & Public Safety (ARS), Aachen City Fire Department, Aachen, Germany"
      ],
      "name": "Anja Sommer"
    },
    {
      "affiliations": [
        "Institute for Public Health in Acute Medicine (IPHAM), Otto von Guericke University Magdeburg, Magdeburg, Germany"
      ],
      "name": "Wiebke Schirrmeister"
    },
    {
      "affiliations": [
        "Institute for Public Health in Acute Medicine (IPHAM), Otto von Guericke University Magdeburg, Magdeburg, Germany"
      ],
      "name": "Felix Walcher"
    },
    {
      "affiliations": [
        "Institute for Public Health in Acute Medicine (IPHAM), Otto von Guericke University Magdeburg, Magdeburg, Germany"
      ],
      "name": "Ronny Otto"
    },
    {
      "affiliations": [
        "Institute for Public Health in Acute Medicine (IPHAM), Otto von Guericke University Magdeburg, Magdeburg, Germany"
      ],
      "name": "Saskia Ehrentreich"
    },
    {
      "affiliations": [
        "Chair of Process and Data Science (PADS), RWTH Aachen University, Aachen, Germany"
      ],
      "name": "Harry H Beyel"
    },
    {
      "affiliations": [
        "Chair of Process and Data Science (PADS), RWTH Aachen University, Aachen, Germany"
      ],
      "name": "Viki Peeva"
    },
    {
      "affiliations": [
        "Chair of Process and Data Science (PADS), RWTH Aachen University, Aachen, Germany"
      ],
      "name": "Christopher T Schwanen"
    },
    {
      "affiliations": [
        "Chair of Process and Data Science (PADS), RWTH Aachen University, Aachen, Germany"
      ],
      "name": "Marco Pegoraro"
    },
    {
      "affiliations": [
        "Central Research Institute of Ambulatory Health Care, Berlin, Germany"
      ],
      "name": "Beate Zoch-Lesniak"
    },
    {
      "affiliations": [
        "North Rhine Association of Statutory Health Insurance Physicians, Düsseldorf, Germany"
      ],
      "name": "Johannes Pollmanns"
    },
    {
      "affiliations": [
        "North Rhine Association of Statutory Health Insurance Physicians, Düsseldorf, Germany"
      ],
      "name": "Ralf Wittmar"
    },
    {
      "affiliations": [
        "Central Research Institute of Ambulatory Health Care, Berlin, Germany"
      ],
      "name": "Dominik Graf von Stillfried"
    },
    {
      "affiliations": [
        "Institute of Medical Informatics, RWTH Aachen University Medical Faculty, Aachen, Germany"
      ],
      "name": "Rainer Röhrig"
    },
    {
      "affiliations": [
        "Anesthesiologie/Emergency Medical Service, RWTH Aachen University, Aachen, Germany"
      ],
      "name": "Stefan K Beckers"
    },
    {
      "affiliations": [
        "Chair of Process and Data Science (PADS), RWTH Aachen University, Aachen, Germany"
      ],
      "name": "Wil M P van der Aalst"
    },
    {
      "affiliations": [
        "Centre for Clinical Acute and Emergency Medicine, University Hospital Aachen, Aachen, Germany"
      ],
      "name": "Jörg Christian Brokmann"
    },
    {
      "affiliations": [],
      "name": "TRANSPARENT Research Group"
    }
  ],
  "title": "Trans-sectoral patient pathways in urgent and emergency care (TRANSPARENT study): protocol for a prospective, mixed-methods study in Germany",
  "uid": "1d89d172-206b-54ee-8d06-f15609740a95"
}