Future of Quality and Outcomes Research in Stroke.

troke is a common and costly condition that affects 15 million people worldwide each year. 1 Globally, stroke results in nearly 6 million deaths, and another 5 million people are permanently disabled by stroke each year. Stroke is the fourth leading cause of death, the second most common reason for hospitalization in older adults, and the most common cause of long-term disability in the United States. 2 Although there have been important advances in stroke treatment and rehabilitation over the past few decades, stroke patients, care partners , and clinicians frequently still have too little information to determine which diagnostic tests, treatments, and strategies to apply and which to avoid in specific instances. There remain critical voids in knowledge about which approaches to stroke care are likely to produce optimal clinical outcomes for the greatest number of patients. In addition, despite well-developed repositories for the assessment of neurological quality of life and other patient-reported outcomes, the field of cerebrovascular disease has been slow to incorporate these measures into care planning and shared decision-making. 3,4 Even when strong evidence exists, there are frequently gaps, variations, and disparities in how that evidence is applied in clinical practice. Challenges remain in accurately capturing and reporting quality and outcomes, including functional outcomes, that are properly risk adjusted. Quality and outcomes research in stroke is essential to bridging these substantial gaps in knowledge, better informing clinical decision making, and driving further improvements in stroke care and outcomes. With the significant disease burden and existing gaps in knowledge in stroke care, stroke quality and outcomes research has been increasingly recognized as a key priority for both researchers and knowledge users. The Institute of Medicine has highlighted stroke as one of the highest priority conditions for clinical and comparative effectiveness research. 5 Comparing the safety and effectiveness of various prevention, diagnosis, and treatment options for stroke has been identified by the Patient-Centered Outcomes Research Institute as one of the 5 national priorities for research. 6 To better inform clinical decisions, there is an urgent need for better and more personalized ways to gauge prognosis and response to treatments. It is also essential to better understand how demographics, comorbid conditions, and other factors interact to influence health, access to care, and response to therapies in people with stroke. There is a need for enhanced approaches to detecting potential safety issues with drugs and devices for patients with stroke. …