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Introduction: During 2012-2015 the Centers for Disease Control and Prevention’s (CDC) Paul Coverdell National Acute Stroke Program (PCNASP) funded 11 state health departments to improve quality of stroke care by developing systems of care that span the continuum of pre-hospital, hospital, and post-hospital care.

Hypothesis: We assessed the hypothesis that state- and health system-level factors facilitate establishing stroke systems of care.

Methods: We conducted 72 semi-structured telephone interviews with stakeholders of the 11 PCNASP grantees, such as program and quality improvement (QI) personnel, and emergency medical services (EMS) and hospital staff. Using grounded theory (Glaser and Strauss), we developed and applied a coding scheme to interview transcripts to identify emerging themes related to factors affecting establishing stroke systems of care.

Results: Findings indicate that state …