Study Protocol: IMPETUS: Implementing a uniform stroke care pathway in medical colleges of India: IMPETUS Stroke

Bhatia, Rohit; Haldar, Partha; Puri, Inder; Srivastava, MV Padma; Bhoi, Sanjeev Kumar; Jha, Menka; Dey, Anupam; Naik, Suprava; Guru, Satyabrata; Singh, Meharban; Vishnu, Venugopalan Y; Rajan, Roopa; Gupta, Anu; Vibha, Deepti; Pandit, AwadhKishore; Agarwal, Ayush; Salunkhe, Manish; Singh, Gunjan; Prasad, D. R. Mahadeshwara; Panda, Samhita; Anand, Sucharita; Rohila, AmitKumar; Khera, PushpinderS; Tiwari, Sarbesh; Bhaskar, S; Garg, Mayank; Dhar, Minakshi; Tiwari, Ashutosha; Agrawal, Naman; Raju, GarudaBuchi; Garg, Jyoti; Ray, BimanKanti; Bhardwaj, Amit; Verma, Alok; Dongre, Nikhil; Chhina, Gurpreet; Sibia, Raminder; Kaur, Rupinderjeet; Zanzmera, Paresh; Gamit, Amit; Iype, Thomas; Garg, Ravinder; Singh, Sulena; Kumar, Ashok; Ranjan, Abhay; Sardana, Vijay; Soni, Deepak; Bhushan, Bharat; Dhamija, RajinderK; Saluja, Alvee; Bala, Kiran; Dabla, Surekha; Goswami, Deepti; Agarwal, Abhimanyu; Shah, Sudhir; Shah, Shalin; Patel, Mayank; Joshi, Pranav; Awasthi, Sanjiv; Nath, Smita; Chandan, Shishir; Malik, Rupali; Chowdhury, Neera

doi:10.4103/aian.aian_1033_21

Cited by 3 publications

(6 citation statements)

References 15 publications

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“…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.…”

Section: Methodsmentioning

confidence: 99%

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

Section: Methodsmentioning

confidence: 99%

“…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.…”

Section: Introductionmentioning

confidence: 99%

“…We designed the IMPETUS stroke study ( Implementation of an evaluation and treatment package for uniform stroke care and outcomes in the medical colleges in India: An Implementation Research Study ; https://impetus.icmr.org.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 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.…”

Section: Introductionmentioning

confidence: 99%

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

Salunkhe

Haldar

Bhatia

et al. 2023

International Journal of Stroke

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Background: India accounts for 13.3% of global disability-adjusted life years (DALYs) lost due to stroke with a relatively younger age of onset compared to the Western population. In India’s public healthcare system, many stroke patients seek care at tertiary-level government-funded medical colleges where an optimal level of stroke care is expected. However, there are no studies from India that have assessed the quality of stroke care, including infrastructure, imaging facilities, or the availability of stroke care units in medical colleges. Aim: This study aimed to understand the existing protocols and management of acute stroke care across 22 medical colleges in India, as part of the baseline assessment of the ongoing IMPETUS stroke study. Methods: A semi-structured quantitative pre-tested questionnaire, developed based on review of literature and expert discussion, was mailed to 22 participating sites of the IMPETUS stroke study. The questionnaire assessed comprehensively all components of stroke care, including human resources, emergency system, in-hospital care, and secondary prevention. A descriptive analysis of their status was undertaken. Results: In the emergency services, limited stroke helpline numbers, 3/22 (14%); prenotification system, 5/22 (23%); and stroke-trained physicians were available, 6/22 (27%). One-third of hospitals did not have on-call neurologists. Although non-contrast computed tomography (NCCT) was always available, 39% of hospitals were not doing computed tomography (CT) angiography and 13/22 (59%) were not doing magnetic resonance imaging (MRI) after routine working hours. Intravenous thrombolysis was being done in 20/22 (91%) hospitals, but 36% of hospitals did not provide it free of cost. Endovascular therapy was available only in 6/22 (27%) hospitals. The study highlighted the scarcity of multidisciplinary stroke teams, 8/22 (36%), and stroke units, 7/22 (32%). Lifesaving surgeries like hematoma evacuation, 11/22 (50%), and decompressive craniectomy, 9/22 (41%), were performed in limited numbers. The availability of occupational therapists, speech therapists, and cognitive rehabilitation was minimal. Conclusion: This study highlighted the current status of acute stroke management in publicly funded tertiary care hospitals. Lack of prenotification, limited number of stroke-trained physicians and neurosurgeons, relatively lesser provision of free thrombolytic agents, limited stroke units, and lack of rehabilitation services are areas needing urgent attention by policymakers and creation of sustainable education models for uniform stroke care by medical professionals across the country.

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Section: Methodsmentioning

confidence: 99%

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

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

Salunkhe

Haldar

Bhatia

et al. 2023

International Journal of Stroke

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

Section: Future Strategies In Stroke Care In Indiamentioning

confidence: 99%

Expert Consensus on Improving Stroke Care Ecosystem in India

Srivastava,

Mehndiratta,

Kaul

et al. 2024

Journal of Stroke Medicine

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The stroke burden in India is alarmingly high compared to Western industrialised countries, necessitating immediate action to develop stroke systems of care. Tailored stroke-prevention strategies, adequate resource allocation for stroke management and research, and increased awareness of specialised care in acute Stroke are critical. The COVID-19 pandemic has underscored the need for improved healthcare delivery and infrastructure. To address the rising stroke burden in India, comprehensive strategies encompassing prevention, awareness, specialised care and governmental support are urgently required. While the concept of ‘stroke-ready centres’ has emerged, their limited availability hinders widespread benefits. This expert consensus examines the current state of stroke care in India, identifies challenges, and proposes strategies to enhance stroke care systems. It offers valuable insights into stroke management at different levels, empowering healthcare professionals and administrators to assess their existing systems and make necessary improvements. Special attention is given to the role of physicians, including the use of thrombolytic therapies like Tenecteplase, in reducing the stroke burden and improving outcomes across the country. Significant strides can be made in stroke management and care in India by addressing these critical areas.

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

Krishnan

Asadullah

Kumar

et al. 2023

The Lancet Regional Health - Southeast Asia

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Study Protocol: IMPETUS: Implementing a uniform stroke care pathway in medical colleges of India: IMPETUS Stroke

Cited by 3 publications

References 15 publications

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

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

Expert Consensus on Improving Stroke Care Ecosystem in 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

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