Abstract HUP10: Implementation of an Evaluation and Treatment Package for Uniform Stroke Care Pathway and Outcomes in the Medical Colleges in India (IMPETUS STROKE): An Implementation Research Study

Background and Aims: Challenges in stroke care exist at multiple levels. In India, medical colleges are crucial in connecting rural and tertiary care public health systems. Our study aims to implement a uniform stroke care pathway (USCP) and assess its sustainability. Methods: IMPETUS Stroke was a multicentric, prospective, multiphase, mixed method, quasi experimental implementation study conducted at 22 government funded medical colleges to examine the changes in a select set of stroke care related indicators over time. It included a pre-implementation phase (Phase-1), followed by an implementation phase (Phase-2) where residents and nursing officers and caregivers were trained and Phase 3, where the sustainability of the USCP was assessed. Results: Patient recruitment in each phase was n=2,018 (19.8%), n=2,179 (21.3%), and n=5,996 (58.8%). Mean age was 59-years and males were higher. Ischemic stroke constituted the largest proportion (60-62%) in all phases. In phase-2, a total of 2103 residents, 2199 nursing officers and 6038 caregivers were trained. Nine of the 22 sites (40%) established their first-ever stroke units. Key stroke care indicators improved from the phase-1 to phase-3: at admission, NCCT (69.6%, 78.1% and 77.0%), CT-angiograms (18.2%, 25.3% and 38.4%), NIHSS (20.3%, 23.7% and 33.1%), thrombolysis rates (39.2%, 65.8% and 70.7%) (p-trend<0.001). The average door-to-CT time significantly decreased (p-trend<0.001), in-hospital stroke management in select indicators improved significantly (p-trend<0.001), in-hospital mortality decreased from 19.4% to 13.5% (p-trend<0.001) and three-months good functional outcome (mRS:0-2) increased from 41.6% to 46.0% (p-trend<0.001) across the phases. Conclusion: The data presented holds significance in showing the effect of implementation in improving stroke services and patient outcomes.

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Journal
Stroke
Published
2026-01-29
DOI
https://doi.org/10.1161/str.57.suppl_1.hup10
Primary Topic
Acute Ischemic Stroke Management
Type
article
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article

Abstract HUP10: Implementation of an Evaluation and Treatment Package for Uniform Stroke Care Pathway and Outcomes in the Medical Colleges in India (IMPETUS STROKE): An Implementation Research Study

Deepti Vibha, Alvee Saluja, Jyoti Garg, Manish Salunkhe et al.
Stroke
Acute Ischemic Stroke Management
article

Abstract HUP10: Implementation of an Evaluation and Treatment Package for Uniform Stroke Care Pathway and Outcomes in the Medical Colleges in India (IMPETUS STROKE): An Implementation Research Study

Deepti Vibha, Alvee Saluja, Jyoti Garg, Manish Salunkhe, Priyanka Samal, Nikhil Dongre, Senior Resident Inder Puri, Raminder Sibia, Kiran Bala, Paresh Zanzmera, Nikhil Sahu, Shishir Chandan, Alok Kumar Verma, Partha Haldar, Pramod Darole, Amit Gamit, Sucharita Anand, Dilip Maheshwari, Gurpreet Chhina, Padma MV Srivastava, Rupali Malik, Thomas Iype, Shweta Gupta, B K Ray, Ashok Kumar, Ravi Bhatia, Anu Gupta, Chithra Lekha P, Seepana Gopi, Deepshikha Prasad, Amit Bhardwaj, Venugopalan Y. Vishnu, Samhita Panda, Garuda Buchi Raju, L H Ghotekar, Imnameren Longkumer, Rajesh Kumar Singh, Rupinderjeet kaur, awadh pandit, Vijay Sardana, Mamta Singh, Bharat Bhushan, Sudhir Shah, Menka Jha, Ashutosh Tiwari, Niraj Kumar, Gajendra Ranga, M.P.S Chawla, Smitha Nath, Risha Sarkar, Ravinder Garg, Ayush Agarwal, Shalin Shah, sulena sulena, Surekha Dabla, Mritunjai Singh, Sanjeev Bhoi, Abhay Ranjan
article en

Abstract

Background and Aims: Challenges in stroke care exist at multiple levels. In India, medical colleges are crucial in connecting rural and tertiary care public health systems. Our study aims to implement a uniform stroke care pathway (USCP) and assess its sustainability. Methods: IMPETUS Stroke was a multicentric, prospective, multiphase, mixed method, quasi experimental implementation study conducted at 22 government funded medical colleges to examine the changes in a select set of stroke care related indicators over time. It included a pre-implementation phase (Phase-1), followed by an implementation phase (Phase-2) where residents and nursing officers and caregivers were trained and Phase 3, where the sustainability of the USCP was assessed. Results: Patient recruitment in each phase was n=2,018 (19.8%), n=2,179 (21.3%), and n=5,996 (58.8%). Mean age was 59-years and males were higher. Ischemic stroke constituted the largest proportion (60-62%) in all phases. In phase-2, a total of 2103 residents, 2199 nursing officers and 6038 caregivers were trained. Nine of the 22 sites (40%) established their first-ever stroke units. Key stroke care indicators improved from the phase-1 to phase-3: at admission, NCCT (69.6%, 78.1% and 77.0%), CT-angiograms (18.2%, 25.3% and 38.4%), NIHSS (20.3%, 23.7% and 33.1%), thrombolysis rates (39.2%, 65.8% and 70.7%) (p-trend<0.001). The average door-to-CT time significantly decreased (p-trend<0.001), in-hospital stroke management in select indicators improved significantly (p-trend<0.001), in-hospital mortality decreased from 19.4% to 13.5% (p-trend<0.001) and three-months good functional outcome (mRS:0-2) increased from 41.6% to 46.0% (p-trend<0.001) across the phases. Conclusion: The data presented holds significance in showing the effect of implementation in improving stroke services and patient outcomes.

StrokeVol. 57(Suppl_1)
Andhra University (IN), Government Medical College (IN), Lady Hardinge Medical College (IN), All India Institute of Medical Sciences Raipur (IN), Safdarjang Hospital (IN), Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences (IN), University College of Medical Sciences (IN), University of Kota (IN), All India Institute of Medical Sciences Jodhpur (IN), Indira Gandhi Institute of Medical Sciences (IN), Sardar Patel Medical College (IN), Guru Gobind Singh Medical College and Hospital (IN), Lokmanya Tilak Municipal General Hospital and Lokmanya Tilak Municipal Medical College (IN), Government Medical College, Amritsar (IN), Bangur Institute of Neurosciences (IN), Ganesh Shankar Vidyarthi Memorial Medical College (IN), Sardar Vallabhbhai National Institute of Technology Surat (IN), All India Institute of Medical Sciences Bhopal (IN), All India Institute of Medical Sciences Bhubaneswar (IN), Dr. Rajendra Prasad Government Medical College (IN), Government Medical College (IN), Army Hospital Research and Referral (IN), All India Institute of Medical Sciences Rishikesh (IN), Ahmedabad University (IN), All India Institute of Medical Sciences (IN)
Openalex Percentile: Top 73%
Acute Ischemic Stroke Management
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