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Background

In May 2012, the health authority (RHA) of the Central Denmark Region decided to transfer inpatient rehabilitation for stroke patients to community-based rehabilitation, as part of a major reform of regional stroke care. It was implemented top-down in three months. Patients were promised a more integrated care pathway with early discharge stroke teams bridging the two sectors. In this decentralized system, hospital care is the responsibility of the Regional health authority, and rehabilitation at home that of municipalities. The implementation of this reform therefore poses some challenges. The HA’s reform required written cooperation agreements to be made by hospitals and municipalities. The implementation of these agreements and their aim of establishing a coordinated rehabilitation pathway was analysed, with a focus on (inter) organisational aspects, as the change was similar throughout the region …