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


1 Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
2 Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi, India
3 Department of Neurology, Sardar Patel Medical College, Bikaner, Rajasthan, India
4 Department of Neurology, All India Institute of Medical Sciences, Bhubaneshwar, Odisha, India
5 Department of Medicine, All India Institute of Medical Sciences, Bhubaneshwar, Odisha, India
6 Department of Radiodiagnosis, All India Institute of Medical Sciences, Bhubaneshwar, Odisha, India
7 Department of Emergency and Trauma Medicine, All India Institute of Medical Sciences, Bhubaneshwar, Odisha, India
8 Department of Neurology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
9 Department of Medicine, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
10 Department of Diagnostic and Interventional Radiology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
11 Department of Neurosurgery, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
12 Department of Neurology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
13 Department of Medicine, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
14 Emergency Medicine, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
15 Department of Neurology, Andhra Medical College, Vishakapatnam, India
16 Department of Neurology, Atal Bihari Vajpayee Institute of Medical Sciences and Dr. Ram Manohar Lohia Hospital, New Delhi, India
17 Department of Neurology Bangur Institute of Neurology, IPGMER, Kolkata, West Bengal, India
18 Department of Neurology, Dr Rajendra Prasad Government Medical College, Tanda, India
19 Department of Neurology, GSVM Medical College, Kanpur, Uttar Pradesh, India
20 Department of Medicine, Government Medical College, Amritsar, Punjab, India
21 Department of Medicine, Government Medical College, Patiala, Punjab, India
22 Department of Neurology, Government Medical College, Surat, Gujarat, India
23 Department of Neurology, Government Medical College, Trivandrum, Kerala, India
24 Department of Medicine, Guru Gobind Singh Medical College and Hospital, Faridkot, Punjab, India
25 Department of Neurology, Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India
26 Department of Neurology, Kota Medical College, Kota, Rajasthan, India
27 Department of Neurology, Lady Harding Medical College, New Delhi, India
28 Department of Neurology, Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences, Rohtak, Haryana, India
29 Department of Neurology, Sardar Vallabhbhai Patel Institute of Medical Sciences and Research, Ahmedabad, Gujarat, India
30 Department of Medicine, University College of Medical Sciences, New Delhi, India
31 Department of Neurology, VMMC & Safdarjung Hospital, New Delhi, India
32 Department of Medicine, VMMC & Safdarjung Hospital, New Delhi, India

Correspondence Address:
Rohit Bhatia,
Professor, Department of Neurology, Room 3, 6th Floor, Neurosciences Centre, All India Institute of Medical Sciences, New Delhi – 110 029
India
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/aian.aian_1033_21

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.


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