Study Protocol

Abstract

Introduction: In India, a national program for stroke (national programme for the control of cardiovascular diseases, diabetes, cancer, and stroke) and stroke management guidelines exist. Its successful implementation would need an organized system of stroke care in practice. However, many challenges exist including lack of awareness, prehospital notification systems, stroke ready hospitals, infrastructural weaknesses, and rehabilitation. We present here a protocol to investigate the feasibility and fidelity of implementing a uniform stroke care pathway in medical colleges of India. Methods and Analysis: This is a multicentric, prospective, multiphase, mixed-method, quasi-experimental implementation study intended to examine the changes in a select set of stroke care-related indicators over time within the sites exposed to the same implementation strategy. We shall conduct process evaluation of the implementation process as well as evaluate the effect of the implementation strategy using the interrupted time series design. During implementation phase, education and training about standard stroke care pathway will be provided to all stakeholders of implementing sites. Patient-level outcomes in the form of modified Rankin Scale score will be collected for all consecutive patients throughout the study. Process evaluation outcomes will be collected and reported in the form of various stroke care indicators. We will report level and trend changes in various indicators during the three study phases. Discussion: Acute stroke requires timely detection, management, and secondary prevention. Implementation of the uniform stroke care pathway is a unique opportunity to promote the requirements of homogenous stroke care in medical colleges of India.

Prevalence and determinants of delays in care among premature deaths due to acute cardiac conditions and stroke in residents of a district in India

“…A similar tele-stroke model appropriate for poor resources countries and development of uniform stroke care pathways are also steps in similar direction. 40 , 41 …”

IMPETUS Stroke: Assessment of hospital infrastructure and workflow for implementation of uniform stroke care pathway in India

“…The outcomes of implementation shall be assessed on defined indicators of stroke care, mortality, and disability. 10…”

“…The following study was undertaken as part of the baseline assessment of the ongoing IMPETUS stroke study. 10 IMPETUS stroke is a multicentric, prospective, multiphase, mixed-methods, quasi-experimental implementation study, comprising three phases. The study was initiated in October 2021.…”

“…in/) with the aim of improving stroke care from the time of recognition in the emergency, in patient management, secondary stroke prevention, and appropriate discharge planning. 10 As part of IMPETUS stroke study, we aimed to assess the current situation of acute stroke care in select 22 medical colleges across India, in terms of the International Journal of Stroke, 19 (1) infrastructural assessment and limitations. The objective of this study was to undertake a situational analysis of the current status of acute stroke care in select medical colleges in India.…”

Expert Consensus on Improving Stroke Care Ecosystem in India

“…The study aims to enhance stroke care from emergency recognition to patient discharge by employing an implementation design. 102…”