A health systems approach to improving the quality of stroke care in hospitals.

Healthcare systems influence the care patients receive. This thesis evaluates three ways of using health-systems to improve quality of stroke management in hospitals. Systematic data collection identified gaps in access to rehabilitation which will guide monitoring to improve future access. Redesign of TIA management in emergency departments reduced hospital demands, but outcomes were initially worse; emphasising the importance of continual monitoring during change. Pay-for-performance incentives increased access to evidence-based stroke unit care and improved survival. “Learning health systems” which use data to identify problems and guide repeated cycles of these and other improvement interventions, have potential to improve patient outcomes.