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

Elke Ge Mathijssen¹, Jaap Ca Trappenburg¹, Mark J Alberts², Angelique Balguid³, Robert J Dempsey⁴, Mayank Goyal⁵, Bianca Ta de Greef³, Marjan J Hummel³, Koji Iihara⁶, Enrique C Leira⁷, Winston Lim⁸, Gregory Yh Lip^{9

10}, Paolo Madeddu¹¹, Randolph S Marshall¹², Dominick Jh McCabe^{13

14}, Ahmad S Muda¹⁵, Dimitrios N Nikas¹⁶, George Ntaios¹⁷, Terence J Quinn¹⁸, Marta Rubiera¹⁹, Tatjana Rundek^{20

21}, Shashank Shekhar²², Wen-Jun Tu²³, Pearl Vyas³, Wim van Zwam²⁴, Johannes B Reitsma¹, Ewoud Schuit¹

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 Department of Clinical Medicine, Danish Center for Health Services Research, Aalborg University, Aalborg, Denmark.
¹¹ Bristol Heart Institute, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.
¹² Department of Neurology, Columbia University Irving Medical Center, New York, NY, USA.
¹³ 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.
¹⁴ Academic Unit of Neurology, Trinity College Dublin School of Medicine, Dublin, Ireland.
¹⁵ Department of Radiology, Faculty of Medicine and Health Sciences, Hospital Pengajar, University Putra Malaysia, Serdang, Malaysia.
¹⁶ 1st Cardiology Department, University General Hospital of Ioannina, Ioannina, Greece.
¹⁷ Department of Internal Medicine, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece.
¹⁸ School of Cardiovascular and Metabolic Health, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK.
¹⁹ Stroke Unit, Department of Neurology, Hospital Vall d'Hebron, Barcelona, Spain.
²⁰ Department of Neurology, University of Miami Miller School of Medicine, Miami, FL, USA.
²¹ Evelyn F. McKnight Brain Institute, University of Miami Miller School of Medicine, Miami, FL, USA.
²² Department of Neurology, Duke University School of Medicine, Durham, NC, USA.
²³ Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
²⁴ Department of Radiology and Nuclear Medicine, Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, The Netherlands.

PMID: 40178329
PMCID: PMC11969492
DOI: 10.1177/23969873251329841

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

Elke Ge Mathijssen et al. Eur Stroke J. 2025 Dec.

. 2025 Dec;10(4):1479-1488.

doi: 10.1177/23969873251329841. Epub 2025 Apr 3.

Authors

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 Department of Clinical Medicine, Danish Center for Health Services Research, Aalborg University, Aalborg, Denmark.
¹¹ Bristol Heart Institute, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.
¹² Department of Neurology, Columbia University Irving Medical Center, New York, NY, USA.
¹³ 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.
¹⁴ Academic Unit of Neurology, Trinity College Dublin School of Medicine, Dublin, Ireland.
¹⁵ Department of Radiology, Faculty of Medicine and Health Sciences, Hospital Pengajar, University Putra Malaysia, Serdang, Malaysia.
¹⁶ 1st Cardiology Department, University General Hospital of Ioannina, Ioannina, Greece.
¹⁷ Department of Internal Medicine, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece.
¹⁸ School of Cardiovascular and Metabolic Health, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK.
¹⁹ Stroke Unit, Department of Neurology, Hospital Vall d'Hebron, Barcelona, Spain.
²⁰ Department of Neurology, University of Miami Miller School of Medicine, Miami, FL, USA.
²¹ Evelyn F. McKnight Brain Institute, University of Miami Miller School of Medicine, Miami, FL, USA.
²² Department of Neurology, Duke University School of Medicine, Durham, NC, USA.
²³ Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
²⁴ Department of Radiology and Nuclear Medicine, Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, The Netherlands.

PMID: 40178329
PMCID: PMC11969492
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.

Keywords: Delphi technique; Stroke; health services; quality improvement; quality indicators; quality measures.

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Conflict of interest statement

Declaration of conflicting interestThe author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: Prof. Dr. Dominick McCabe’s Vascular Neurology Research program is currently supported by grants from The Meath Foundation, Ireland; The Adelaide Health Foundation, Ireland; The Vascular Neurology Research Foundation Ireland; the Enterprise Ireland-Innovation Partnership Programme (co-funded by the European Regional Development Fund); and by unrestricted educational grant funding from Werfen, Spain; Sysmex UK/Siemens, Germany; SINNOWA Medical Science & Technology Co., China; and Acquis BI Technology Ltd., Ireland. The other authors report no competing interests.

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

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

Authors

Affiliations

Abstract

Conflict of interest statement

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