Research has shown that there are higher stroke mortality rates in rural areas, but these seem to be attributable to higher stroke incidence rather than case fatality. Additionally, Critical Access Hospitals (CAHs) have higher mortality rates than non-CAHs. All hospitals in rural areas need to be prepared to assess and treat stroke patients or know when patients need additional care their rural hospital may not be able to provide.

This policy brief describes successful evidence-based programs that have been implemented to improve stroke care in CAHs and other rural hospitals.

Key Findings:

• Across the U.S., there are some excellent initiatives focused on improving the quality of stroke care available to rural communities through Critical Access Hospitals (CAHs).
• Education and training are the most common components of stroke care quality improvement initiatives, and along with community awareness are central to improving the identification, protocols, and treatment practices of stroke care in rural communities.
• It is important for CAH stroke quality improvement initiatives to include data collection and analysis as a component of their initiative, with measures looking at Door-to-Needle Time and Pre-Notification by EMS being the most important measures.
• The majority of CAH stroke quality improvement initiatives rely heavily on partnerships with various organizations, including the American Heart Association/American Stroke Association for training and data support, as well as state-level EMS offices and local EMS agencies to focus on identification and pre-notification of strokes for CAHs.