Development of a Telestroke Network to improve Stroke Care: A Quasi Experimental Study(TeStNet)

India is a country where majority of the population live in the rural areas where evidence based stroke care is lacking as most of the neurologists, stroke specialists, and stroke-ready hospitals are located in major cities far from the reach of the rural population. Stroke awareness is lacking amongst many people resulting in unnecessary delay in seeking proper medical attention and timely presentation to a stroke-ready hospital. Telemedicine can be utilised to provide expert guidance to remote hospitals which are within the reach of the rural population. Availability of stroke experts via telemedicine can convert these hospitals to stroke-ready hospitals and improve the overall stroke care. Telemedicine can also be utilised to connect the community level health workerswith the stroke experts to raise stroke-related awareness and reduce prehospital delay. In this study our aim is to explore the efficacy of telemedicine in reducing stroke-related morbidity and mortality in hospitals connected to a neurology facility in comparison with similar hospitals lacking telemedicine facility. We also want to study the efficacy of telemedicine in the reduction of prehospital delayby connecting community level health workers with stroke experts. In this quasi-experimental study we will evaluate and compare the efficacy of two intervention models, namely ‘Comprehensive Telestroke model’ which not only provides telemedicine support to a remote hospital but also raises community awareness to reduce prehospital delay, and ‘Conventional Telestroke model’ which provides telemedicine support only but does not address the community awareness component.