Protocol for the development of a comprehensive telestroke network to improve stroke care in developing countries: The TeStNet trial

Background: Stroke-ready hospitals are very limited in West Bengal, but the knowledge of stroke is more limited in general society. In India, telemedicine has been proven to be useful in the management of acute ischemic stroke at hospitals where neurologists are not available. Raising community awareness and establishing a network at the grassroots level is essential. Objective: This study aims to develop a comprehensive telestroke model and evaluate its effectiveness in determining the outcome of stroke patients. Another aim was to compare the effectiveness of the comprehensive telestroke model over the conventional telestroke model. Materials and Methods: One hub and nine spoke centers were chosen to implement this study. Among these, three spokes were Group A, where the stroke awareness was given to the community and the telestroke facilities and acute stroke management facilities were available. Three spokes were Group B, where telestroke facilities and acute stroke management facilities were available. Three spokes were Group C, where only acute stroke management facilities were available. Data were recorded in a pretested, predesigned, semistructured schedule. Results: IPGMER, Kolkata was selected as the HUB hospital and the other 9 hospitals were selected for this study and were grouped as follows: Group A- i) Diamond Harbour Government Medical College and Hospital, ii) Basirhat Superspeciality Hospital, iii) Suri Superspeciality Hospital; Group B- i) Jhargram Government Medical College and Hospital, ii) Bishnupur Superspeciality Hospital, iii) Alipurduar District Hospital; Group C- i) Prafulla Chandra Sen Government Medical College and Hospital, ii) Jangipur Superspeciality Hospital, iii) Islampur Superspeciality Hospital. Discussion:This study helps understand the actual effectiveness of the comprehensive hub-and-spoke telestroke model over the existing conventional telestroke model. These findings help improve proper healthcare planning and health policy-making in the future. Conclusion: The TeStNet trial provides a framework for the development of a new model of comprehensive stroke care service described as the Hub-Spoke-Sub spoke model.