Acute stroke treatment in the community: improving our performance and expanding our options.

Three-quarters of all strokes are managed outside of academic medical centers, making optimization of stroke care in the community setting a central part of minimizing the disability from stroke. In addition, the care of stroke patients crosses multiple different components of the health care system and requires a multifaceted and coordinated approach. This article reviews the current status of stroke care across the care continuum and reviews methods found to be effective in educating the public and organizing regional delivery of hyperacute stroke care. Successful community-based stroke care models and current national initiatives in improving hospital management are discussed. Local implementation of these strategies provides an exciting opportunity to improve outcomes after stroke.