Availability and type of stroke services across India: a survey study
Authors: Jones Stephanie P , Baqai Kamran , Georgiou Rachel , Hackett Maree L , Lightbody Catherine E , Maulik Pallab K , Srivastava MV Padma , Pandian Jeyaraj D , Sylaja PN , Watkins Caroline L 
Published: November 2024

Background
Stroke unit care is known to improve patient outcomes, but throughout India, there are few dedicated stroke units.

Aim
Our aim was to undertake a survey of stroke services, stroke workforce and engagement in stroke research across India.

Design and methods
A hospital-based survey tool, informed by the World Stroke Organization Roadmap to Delivering Quality Stroke Care and through discussions with local stakeholders, was developed. The tool explored the availability of stroke units, diagnostic services, telemedicine, thrombolysis, thrombectomy, stroke workforce, education and training opportunities, services to support stroke survivors and their families, and organisational involvement in research. Data were analysed descriptively and grouped by hospital status (private or public).

Setting
A convenience sample of healthcare professionals representing hospitals providing stroke care in India.

Participants
Respondents comprised physicians, nurses, physiotherapists, researchers and speech and language therapists. Where more than one representative from a hospital completed the survey tool, the responses from the most senior member of staff were selected and included in the analysis.

Results
Ninety-five hospitals participated (December 2017 and August 2019), resulting in data representing 15 states and 2 union territories. Fifty (53%) hospitals were private and 45 (47%) were public. Fifty-six (59%) hospitals reported treating a total of 20,661 stroke patients over a 12-month period (median 300; interquartile range 173–461). Only half of all hospitals had a dedicated stroke unit with a total of 596 stroke beds (median 9 beds per unit; interquartile range 6–11).

Limitations
The hospitals in this study were mainly recruited via two national conferences and an international conference (International Conference on the Essentials of Stroke Care); the Indian Stroke Clinical Trial Network, the Indian Stroke Association and the Indian Academy of Neurology. There was a high completion rate from representatives in Kerala; 14 states and 5 union territories were not represented. We did not seek to identify all hospitals caring for stroke patients and therefore do not know the number of non-identified/non-responding sites and, as such, the findings may not be representative. It was not possible to gain individual contact information for hospital and regional government administrators who may have access to stroke data. It is likely that there have been major changes to stroke services as a result of the COVID-19 pandemic.

Conclusion
Dedicated stroke units, stroke-specific staff, education, training and research opportunities, diagnostic services and specialist treatments were mostly available within private hospitals; however, there is a paucity of available stroke services data. Further research is needed to map stroke service provision in a wider range of tertiary stroke care providers and stroke units.

Future work
Currently, there is variability in the levels and types of stroke unit resources available. The recent World Stroke Organization and National Accreditation Board of Hospitals and Healthcare providers joint Stroke Centre certification programme aims to create the standardised delivery of stroke care across India. Future work will involve working with the World Stroke Organization and National Accreditation Board of Hospitals and Healthcare to facilitate the inclusion criteria of evidence-based Care Bundles, as part of National Accreditation Board of Hospitals and Healthcare accreditation across India.

Funding
This article presents independent research funded by the National Institute for Health and Care Research (NIHR) Global Health Research programme as award number GHR 16/137/16.