Organizing regional stroke systems of care

Purpose of review Stroke is a major public health problem in the US and other developed countries. Stroke units reduce morbidity and mortality, and the efficacy of thrombolytic therapy propelled the development and maturation of a stroke systems of care delivery model. This model addresses the key domains in the chain of stroke survival and recovery, including primordial and primary prevention; community education; notification and response of emergency medical services; acute stroke treatment; subacute stroke treatment and secondary prevention; rehabilitation; and continuous quality improvement activities within each domain and across the system itself. Recent findings To improve care delivery to all, systems must be implemented that link these domains together, and successful examples of these activities are reviewed in detail. Summary Harmonization of efforts by the major healthcare organizations to collect data on hospital-based stroke care and improve care will lead to broader implementation of these programs and better patient outcomes. Health policy changes are needed at the state, regional and federal level to increase funding for stroke education and provider reimbursement, improve provider capabilities and address shortages of acute stroke expertise nationwide. Telemedicine and air medical transport play a key role in creating networks of stroke care that link together hospitals of different capabilities.