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To improve stroke patient care, the American Heart Association/American Stroke Association (AHA/ASA) provided policy recommendations in 2013 for key elements of stroke systems of care, including emergency medical services (EMS) routing policies, use of telemedicine where specialists are scarce, multidisciplinary and protocol-driven in-hospital care, conduction of quality improvement programs, and access to poststroke rehabilitation.1 In 2014, the AHA/ASA considered the evidence for factors that may have contributed to the accelerated decline in stroke mortality over the past few decades and found surprisingly sparse evidence for outcomes improvement resulting from integration of these distinct elements into a stroke system of care.2
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