title: The process flow and structure of an integrated stroke strategy.
abstract: BACKGROUND
  In the Canadian province of Alberta access and quality of stroke care were suboptimal, especially in remote areas. The government introduced the Alberta Provincial Stroke Strategy (APSS) in 2005, an integrated strategy to improve access to stroke care, quality and efficiency which utilizes telehealth.
  
  
  OBJECTIVE
  What is the process flow and the structure of the care pathways of the APSS?
  
  
  METHODS
  Information for this article was obtained using documentation, archival APSS records, interviews with experts, direct observation and participant observation.
  
  
  RESULTS
  The process flow is described. The APSS integrated evidence-based practice, multidisciplinary communication, and telestroke services. It includes regular quality evaluation and improvement.
  
  
  CONCLUSIONS
  Access, efficiency and quality of care improved since the start of the APSS across many domains, through improvement of expertise and equipment in small hospitals, accessible consultation of stroke specialists using telestroke, enhancing preventive care, enhancing multidisciplinary collaboration, introducing uniform best practice protocols and bypass-protocols for the emergency medical services.
  
  
  CONCLUSIONS
  The APSS overcame substantial obstacles to decrease discrepancies and to deliver integrated higher quality care. Telestroke has proven itself to be safe and feasible. The APSS works efficiently, which is in line to other projects worldwide, and is, based on limited results, cost effective. Further research on cost-effectiveness is necessary.
authors.affiliation: BovenIJ Hospital, Amsterdam, The Netherlands.
authors.forename: Emma F
authors.initials: EF
authors.lastname: van Bussel
authors.forename: Thomas
authors.initials: T
authors.lastname: Jeerakathil
authors.forename: Augustinus J P
authors.initials: AJ
authors.lastname: Schrijvers
keywords: Canada; integrated care; neurology; stroke; telemedicine; telestroke