Implementing International Standards of Practice in A Low Resource Country by Blended Training Modules to Improve Stroke Care
Studieöversikt
Status
Betingelser
Intervention / Behandling
Detaljerad beskrivning
Background: Lack of proper stroke care delivery leads to poor patient outcomes in middle- and low-income countries that can be improved by implementation of international standards. We aim to determine feasibility of implementing stroke core measures and training through blended learning modules in resource poor countries to improve stroke outcomes.
Methods: The project will be conducted across four hospitals in Pakistan in three phases. First stage will include retrospective collection of data for the preceding 4 weeks from start. In stage II, 3 months data will be collected before implementation of core measures. The stepwise training of staff will begin simultaneously, and data will continue to be collected. In stage III by the end of 3 months of stage II, core measures will be implemented as standard of care and patients will be enrolled for another 3 months. Outcomes measures will be successful implementation of the stroke care model as measured by survey done at the end and patient outcomes including in-hospital complication rates, length of hospital stay, patient and caregiver education, mRS at 3 months after discharge, post discharge complications and re-stroke rate. Data will be compared against published data from Pakistan and between patients in the first and last 3 months of the project. Statistical analyses will include appropriate mixed-effects multivariate regression models (i.e., linear and logistic) to model the relationship between clinical measures and patient safety. Degree of correlation across each symptom predictor will be measured. This study will not involve thrombolytic therapy or thrombectomy. However, the study will not provide any hindrance to implementation of such therapy and will not include such patients in analysis.
Discussion: At least one third of stroke survivors in Pakistan die due to recurrent vascular events and complications of stroke in absence of core measures. Prevention practices and stroke care are significantly underutilized in low- and middle-income countries but can be improved most efficiently by improving care delivering process without additional burden on resources by following American Heart Association "Get With The Guidelines" Stroke (GWTG-Stroke) program, Royal College of Physicians UK and European Guidelines, regardless of thrombolysis or thrombectomy. This feasibility study aims to develop a multidisciplinary comprehensive stroke team model with gradual integration of staff training, nursing care, therapy and patient education.
Studietyp
Inskrivning (Faktisk)
Kontakter och platser
Studieorter
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Punjab
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Rawalpindi, Punjab, Pakistan, 46000
- Fauji Foundation Hospital
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Deltagandekriterier
Urvalskriterier
Åldrar som är berättigade till studier
Tar emot friska volontärer
Kön som är behöriga för studier
Testmetod
Studera befolkning
Beskrivning
Inclusion Criteria:
Acute onset of Symptoms in the last 24 hours suggestive of stroke Age > 18 years Ischemic or hemorrhagic stroke
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Exclusion Criteria:
Presenting after 24 hours of onset of symptoms Alternate explanation for presenting symptoms (stroke mimics) Family (Surrogate Decision Maker) or next of kin/ patient refusal for participation Transfer of care from another department or hospital Care needed in another department (e.g, ICU, other department) GCS (Glasgow Coma Scale) below 5 or End of life care initiated TIA (Transient Ischemic Attack)
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Studieplan
Hur är studien utformad?
Designdetaljer
Kohorter och interventioner
Grupp / Kohort |
Intervention / Behandling |
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Retrospective 3 months cohort (admitted stroke patients)
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Prospective pre-implementation "standard of core care quality measures" cohort
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Prospective post-implementation "standard of core care quality measures" cohort
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Vad mäter studien?
Primära resultatmått
Resultatmått |
Åtgärdsbeskrivning |
Tidsram |
|---|---|---|
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Post Core Measure Delivery
Tidsram: From date of randomization until the date of first documented progression or date of death from any cause, whichever came first, assessed up to 6 months
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• Primary outcome measure will be successful implementation of the stroke care model as measured by survey done at the end assessing engagement and ability to continue the program in future and ability to implement the program across institutions.
This will be measured by the NIHSS training, stroke education, awareness of core measures, the regularity of following the core measure and data collection.
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From date of randomization until the date of first documented progression or date of death from any cause, whichever came first, assessed up to 6 months
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Sekundära resultatmått
Resultatmått |
Åtgärdsbeskrivning |
Tidsram |
|---|---|---|
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Modified Rankin Scale
Tidsram: From date of randomization until the date of first documented progression or date of death from any cause, whichever came first, assessed up to 7 days
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Modified Rankin Scale is a 6 point disability scale from 0-6, and a greater score means worse outcome.
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From date of randomization until the date of first documented progression or date of death from any cause, whichever came first, assessed up to 7 days
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New ischemic stroke or Transient Ischemic Attack:
Tidsram: From date of randomization until the date of first documented progression or date of death from any cause, whichever came first, assessed up to 7 days
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From date of randomization until the date of first documented progression or date of death from any cause, whichever came first, assessed up to 7 days
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Hemorrhagic transformation:
Tidsram: From date of randomization until the date of first documented progression or date of death from any cause, whichever came first, assessed up to 7 days
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From date of randomization until the date of first documented progression or date of death from any cause, whichever came first, assessed up to 7 days
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Intracranial hemorrhage:
Tidsram: From date of randomization until the date of first documented progression or date of death from any cause, whichever came first, assessed up to 7 days
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From date of randomization until the date of first documented progression or date of death from any cause, whichever came first, assessed up to 7 days
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Death
Tidsram: From date of inclusion in the study until the date of discharge
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From date of inclusion in the study until the date of discharge
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Samarbetspartners och utredare
Sponsor
Studieavstämningsdatum
Studera stora datum
Studiestart (Faktisk)
Primärt slutförande (Faktisk)
Avslutad studie (Förväntat)
Studieregistreringsdatum
Först inskickad
Först inskickad som uppfyllde QC-kriterierna
Första postat (Faktisk)
Uppdateringar av studier
Senaste uppdatering publicerad (Faktisk)
Senaste inskickade uppdateringen som uppfyllde QC-kriterierna
Senast verifierad
Mer information
Termer relaterade till denna studie
Ytterligare relevanta MeSH-villkor
Andra studie-ID-nummer
- FUI/CTR/2020/8
Plan för individuella deltagardata (IPD)
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Läkemedels- och apparatinformation, studiedokument
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