Introduction

The Canadian Stroke Strategy (CSS) was established by the Canadian Stroke Network and the Heart and Stroke Foundation of Canada to reduce the burden of stroke by closing the gap between knowledge and practice in stroke management.

Why is better stroke management important?

• Every year, approximately 50,000 strokes and transient ischemic attacks are treated in Canadian hospitals. Moreover, it is estimated that for each symptomatic stroke, there are nine “silent” strokes that result in cognitive impairment.
• Stroke and other cerebrovascular diseases are the third leading cause of death in Canada.
• Stroke is the leading cause of adult disability, with some 300,000 Canadians living with the effects of stroke.
• The annual cost of stroke is approximately $3.6 billion, taking into account both healthcare costs and lost economic output.
• The human cost of stroke is immeasurable.

The CSS brings together stakeholders and partners to develop and implement a coordinated and integrated approach to stroke prevention, treatment, rehabilitation, and community reintegration in every province and territory in Canada. Its goal is to enhance access to integrated, high-quality, and efficient stroke services for all Canadians, and to contribute to innovative health system reform in Canada and internationally.

There is sound evidence showing what can be done to optimize stroke prevention and care, and compelling results from those who have adopted best practices in organizing and delivering stroke care. By monitoring performance, the impact can be assessed and further action taken. The Canadian Best Practice Recommendations for Stroke Care are presented within this continuous improvement context and are written for health system planners, funders, administrators, and healthcare professionals, all of whom have important roles in the optimization of stroke prevention and care and who are accountable for results.

The CSS provides a framework to drive system improvement and facilitate the adoption of evidence-based best practices in stroke across the continuum of care. Within this framework, the CSS has established platforms for action and working groups that focus at three levels:

• Nationally to address priority initiatives and support provincial and territorial work through coordination, content development, and communication. Work at this level also includes collaboration and alignment with national agencies and other disease strategies.
• Provincially or territorially to help shape health system planning, funding, and structural change.
• Regionally and/or locally to support the implementation of best practices in stroke at the front lines of healthcare.

The goal of the CSS’s best practices and standards platform is to transform stroke prevention and care by ensuring that evidence-based best practices are widely disseminated and used in the Canadian healthcare system. The Best Practices and Standards Working Group (see Appendix 1 for membership list) engages a broad range of contributors through consensus-building initiatives to develop, disseminate, and support uptake of evidence-based best practices, standards, and guidelines.

The Canadian Best Practice Recommendations for Stroke Care, originally released in 2006, is updated every two years to ensure that it is current and coordinated with other similar initiatives nationally and internationally, and that it reflects best practice evidence and stroke management priorities.^{1, 2} The CSS aligns its performance measurement and professional development initiatives with the best practice recommendations to enhance recommendation uptake and implementation, and to monitor the impact on patient care and outcomes.