Prioritizing gaps in stroke care: A two-round Delphi process

Mathijssen EG 1 , Trappenburg JC 1 , Alberts MJ 2 , Balguid A 3 , Dempsey RJ 4 , Goyal M 5 Show all authors , de Greef BT 3 , Hummel MJ 3 , Iihara K 6 , Leira EC 7 , Lim W 8 , Lip GY 9 , Madeddu P 10 , Marshall RS 11 , McCabe DJ 12 , Muda AS 13 , Nikas DN 14 , Ntaios G 15 , Quinn TJ 16 , Rubiera M 17 , Rundek T 18 , Shekhar S 19 , Tu WJ 20 , Vyas P 3 , van Zwam W 21 , Reitsma JB 1 , Schuit E 1

Affiliations 

  • 1 Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, The Netherlands
  • 2 Ayer Neuroscience Institute, Hartford HealthCare Corporation, Hartford, CT, USA
  • 3 Philips Healthcare, Eindhoven, The Netherlands
  • 4 Department of Neurological Surgery, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, USA
  • 5 Department of Radiology and Clinical Neurosciences, Health Sciences Library, Foothills Medical Centre, University of Calgary, Calgary, AB, Canada
  • 6 National Cerebral and Cardiovascular Center Hospital, Suita, Osaka, Japan
  • 7 Departments of Neurology, Neurosurgery, Carver College of Medicine, and Epidemiology, College of Public Health, University of Iowa, Iowa City, IA, USA
  • 8 Department of Diagnostic Radiology, Singapore General Hospital, Singapore, Singapore
  • 9 Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University, Liverpool, UK
  • 10 Bristol Heart Institute, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
  • 11 Department of Neurology, Columbia University Irving Medical Center, New York, NY, USA
  • 12 Vascular Neurology Research Foundation, Department of Neurology and Stroke Service, Tallaght University Hospital/The Adelaide and Meath Hospital, National Children's Hospital (AMNCH), Dublin, Ireland
  • 13 Department of Radiology, Faculty of Medicine and Health Sciences, Hospital Pengajar, University Putra Malaysia, Serdang, Malaysia
  • 14 1st Cardiology Department, University General Hospital of Ioannina, Ioannina, Greece
  • 15 Department of Internal Medicine, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
  • 16 School of Cardiovascular and Metabolic Health, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
  • 17 Stroke Unit, Department of Neurology, Hospital Vall d'Hebron, Barcelona, Spain
  • 18 Department of Neurology, University of Miami Miller School of Medicine, Miami, FL, USA
  • 19 Department of Neurology, Duke University School of Medicine, Durham, NC, USA
  • 20 Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
  • 21 Department of Radiology and Nuclear Medicine, Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, The Netherlands
Eur Stroke J, 2025 Apr 03.
PMID: 40178329 DOI: 10.1177/23969873251329841

Abstract

BACKGROUND: Despite international recognition of stroke as a significant health priority, discrepancies persist between the target values for stroke quality measures and the actual values that are achieved in clinical practice, referred to as gaps. This study aimed to reach consensus among international experts on prioritizing gaps in stroke care.

METHODS: A two-round Delphi process was conducted, surveying an international expert panel in the field of stroke care and cerebrovascular medicine, including patient representatives, healthcare professionals, researchers, policymakers, and medical directors. Experts scored the importance and required effort to close 13 gaps throughout the stroke care continuum and proposed potential solutions. Data were analyzed using descriptive statistics and qualitative analysis methods.

RESULTS: In the first and second Delphi rounds, 35 and 30 experts participated, respectively. Expert consensus was reached on the high importance of closing 11 out of 13 gaps. Two out of 13 gaps were considered moderately important to close, with expert consensus for one of these two gaps. Expert consensus indicated that only one gap, related to the prevention of complications after stroke, requires moderate effort to close, whereas the others were considered to require high effort to close. Key focus areas for potential solutions included: "Care infrastructure," "Geographic disparities," "Interdisciplinary collaboration," and "Advocacy and funding."

CONCLUSIONS: While closing gaps in stroke care primarily requires high effort and substantial resources, targeted interventions in the identified key focus areas may provide feasible and clinically meaningful improvements.

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.

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