Advances in health policy and outcomes.

Many countries seem at last to be taking stroke seriously, recognizing that it is a treatable disease and that failing to treat it effectively results in unnecessary suffering and a huge waste of health service resources. However, too many patients in high, low, and middle income countries still receive inadequate care. Rates of thrombolysis in most countries are still below 1% and in only a few countries is there more than a 50% chance that a patient will be treated in a specialized stroke unit. Access to brain imaging is often too slow and rehabilitation, particularly after the acute phase, is frequently absent or lacking in the necessary quantity or quality.1,2 Recognition that there is a need for central planning, which should be done as a collaborative effort between clinicians, healthcare planners and politicians, is described in the essay by Larry Goldstein3 using the United States experience of policy development for stroke at a national and state level. He stresses the importance of clinicians being willingly engaged in the process to provide high quality information and expertise. George et al4 identify the importance of the components of a public health strategy designed to improve the quality of stroke care at a state level. The key issues are provision of leadership through policy development and assurance, sharing of information with providers, building capacity for conducting quality improvement activities and providing evidence-based guidelines, policies and plans as well as developing and enforcing laws and regulations to ensure the quality of stroke care. All of this requires the active participation of stakeholders and high quality data defining how care is being provided. England is embarking on an ambitious program of redesign of stroke services at a national level. After years of repeated national audits demonstrating the inadequacy of stroke care, …