{
  "abstract": "Introduction Urgent and emergency care (UEC) systems in England face unprecedented pressures, with record accident and emergency attendances, persistent breaches of ambulance response targets and poorer outcomes for time-sensitive conditions. National UEC recovery plans have introduced multiple innovations—such as same-day emergency care, virtual wards and specialty hubs—to manage these pressures and improve patient flow. Rural coastal areas are particularly vulnerable to excessive demand due to higher levels of deprivation, older populations with complex health needs, seasonal surges that generate unpredictable demand and challenges in attracting and retaining staff. Following the Chief Medical Officer’s 2021 Annual Report, funding research and developing bespoke solutions to manage UEC demand and address geographical disparities has been recognised as a national priority. The Elevate study responds to this priority by identifying and evaluating innovative models of UEC in rural coastal communities in England.Methods and analysis The Elevate study is a 30-month, mixed-methods evaluation that comprises three interlinked work packages: (1) National service mapping—outlining provision of innovative models of UEC in rural coastal areas of England. This will be developed through document review and interviews with regional and national service leaders. (2) Quantitative analysis—quasiexperimental and longitudinal approaches will use National Health Service (NHS) England’s Emergency Care Data Set and linked routine NHS datasets to evaluate the impact of UEC models on health and process outcomes. Standard and bespoke metrics will be developed and used to assess performance. (3) Qualitative case studies—up to 12 case studies of UEC models in rural coastal communities. Interviews with patients and staff and non-participant observation will explore how and why different UEC models influence patient experience, clinical outcomes, resource use and the workforce. Findings will be integrated using the Consolidated Framework for Implementation Research to identify components of UEC models that are effective, scalable and sensitive to local context,Ethics and dissemination Ethical approval for qualitative components was granted by the North of Scotland Research Ethics Committee (25/NS/0099). Dissemination will include peer-reviewed publications, policy briefs, creative media and community engagement activities to ensure findings are communicated inclusively and effectively to policymakers, health and social care practitioners and the public.Trial registration number Research Registry (researchregistry11126).",
  "authors": [
    {
      "affiliations": [
        "York Trials Unit, Department of Health Sciences, University of York, York, UK"
      ],
      "name": "Pete Lampard"
    },
    {
      "affiliations": [
        "York Trials Unit, Department of Health Sciences, University of York, York, UK"
      ],
      "name": "Joy Adamson"
    },
    {
      "affiliations": [
        "York Trials Unit, Department of Health Sciences, University of York, York, UK"
      ],
      "name": "Helen Anderson"
    },
    {
      "affiliations": [
        "Research and Innovation, York and Scarborough Teaching Hospitals NHS Foundation Trust, York, UK"
      ],
      "name": "Lisa Ballantine"
    },
    {
      "affiliations": [
        "Yorkshire Ambulance Service NHS Trust, Wakefield, Wakefield, UK"
      ],
      "name": "Fiona Bell"
    },
    {
      "affiliations": [
        "Academic Department of Emergency Care, The University Hospitals NHS Foundation Trust, Bristol, UK",
        "Faculty of Health & Life Sciences, The University of the West of England, Bristol, UK"
      ],
      "name": "Jonathan Richard Benger"
    },
    {
      "affiliations": [
        "Age UK Scarborough, Scarborough, UK",
        "SeeCHANGE Scarborough, Scarborough, UK"
      ],
      "name": "Rebecca Louise Blakey"
    },
    {
      "affiliations": [
        "Research and Innovation, York and Scarborough Teaching Hospitals NHS Foundation Trust, York, UK"
      ],
      "name": "Phillip Dickinson"
    },
    {
      "affiliations": [
        "East Midlands Ambulance Service NHS Trust, Nottingham, UK"
      ],
      "name": "Steven Dykes"
    },
    {
      "affiliations": [
        "Centre for Health Economics, University of York, York, UK"
      ],
      "name": "James Gaughan"
    },
    {
      "affiliations": [
        "School of Medicine and Dentistry, University of Lancashire, Preston, UK"
      ],
      "name": "Stuart Maitland-Knibb"
    },
    {
      "affiliations": [
        "Centre for Evidence and Implementation Science, University of Birmingham, Birmingham, UK"
      ],
      "name": "Daniel Mensah"
    },
    {
      "affiliations": [
        "Age UK Scarborough, Scarborough, UK",
        "SeeCHANGE Scarborough, Scarborough, UK"
      ],
      "name": "Zacharia Alice Ransome"
    },
    {
      "affiliations": [
        "Centre for Health Economics, University of York, York, UK"
      ],
      "name": "Gerry Richardson"
    },
    {
      "affiliations": [
        "Centre of Health Economics, University of York, York, UK"
      ],
      "name": "Rita Santos"
    },
    {
      "affiliations": [
        "York Trials Unit, Department of Health Sciences, University of York, York, UK"
      ],
      "name": "Rebecca Sheridan"
    },
    {
      "affiliations": [
        "Centre of Health Economics, University of York, York, UK"
      ],
      "name": "Peter Sivey"
    },
    {
      "affiliations": [
        "York and Scarborough Teaching Hospitals NHS Foundation Trust, York, UK"
      ],
      "name": "Ed Smith"
    },
    {
      "affiliations": [
        "Centre for Health Economics, University of York, York, UK"
      ],
      "name": "Wei Song"
    },
    {
      "affiliations": [
        "Yorkshire Ambulance Service NHS Trust, Wakefield, Wakefield, UK"
      ],
      "name": "Martin Sutcliffe"
    },
    {
      "affiliations": [
        "Research and Innovation, York and Scarborough Teaching Hospitals NHS Foundation Trust, York, UK"
      ],
      "name": "Cameron Jack Stockwell"
    },
    {
      "affiliations": [
        "Faculty of Health & Life Sciences, The University of the West of England, Bristol, UK"
      ],
      "name": "Sarah Voss"
    },
    {
      "affiliations": [
        "Centre for Evidence and Implementation Science, University of Birmingham, Birmingham, UK"
      ],
      "name": "Arabella Scantlebury"
    }
  ],
  "title": "Identifying innovative models of urgent care in rural coastal areas in England: the Elevate study - a mixed-methods protocol",
  "uid": "5acd2f1b-12dc-5508-9ab5-8eac4d105267"
}