Australian Health Review February 2006 Vol 30 No 1 109 Access Aust Health Rev ISSN: 0156-5788 1 Feb- ruary 2006 30 1 109-118 ©Aust Health Rev 2006 www.aushealthre- view.com.au Access Abstract Level 1 evidence for management of patients with stroke in a dedicated Stroke Care Unit (SCU) demonstrates improved outcomes by about 20%. It has been estimated that 21% of Australian hospitals provide an SCU and that these SCUs are mainly located in either metropolitan sites and/ or in hospitals with more than 300 beds. To address equity issues related to access to SCUs, the National Stroke Foundation and the Australian Government undertook the National Stroke Units Program. One program outcome was the develop- ment of a conceptual model of acute stroke ser- vice delivery. The development process and initial evaluation of the model are described. Use of the model to increase capacity within the health care Aust Health Rev 2006: 30(1): 109–118 system to treat stroke is discussed. IN AUSTRALIA, STROKE is the second greatest cause of total disease burden as calculated using disabil- ity adjusted life year methodology. 1 About 89% of Australians who suffer stroke are admitted to hos- pital, 2 with care provided mainly within the public health system. Well designed clinical trials con- tinue to provide information about how best to manage and treat stroke. There is now evidence that the use of intravenous thrombolysis within 3 hours of ischaemic stroke onset, 3 and aspirin within 48 hours, 4 improves outcomes. Further, level I evidence for organised specialist care in a Stroke Care Unit (SCU) has also been shown to substantially improve outcomes compared with conventional (general) management. 5 A recent sys- tematic review provided evidence that mortality was improved by 18% and functional outcome by 22% at final follow up (median one year). 6 Dominique A Cadilhac, MPubHlth, BNurs, Manager, Public Health Division Geoffrey A Donnan, MD, Director; and Professor, The University of Melbourne National Stroke Research Institute, Melbourne, VIC. Marjory L Moodie, DPH, Research Fellow Health Economics Group, School of Population Health, The University of Melbourne, Melbourne, VIC. Erin E Lalor, PhD, Chief Executive Officer, National Stroke Foundation National Stroke Foundation, Melbourne, VIC. Lucinda E Bilney, MBA, Community team leader Multiple Sclerosis Society of Victoria, Melbourne, VIC. Correspondence: Ms Dominique A Cadilhac, National Stroke Research Institute, Level 1 Neurosciences Building, Repatriation Hospital, 300 Waterdale Road, Melbourne, VIC 3081. dcadilhac@nsri.org.au Improving access to evidence-based acute stroke services: development and evaluation of a health systems model to address equity of access issues Dominique A Cadilhac, Marjory L Moodie, Erin E Lalor, Lucinda E Bilney and Geoffrey A Donnan, on behalf of the National Stroke Foundation What is known about the topic? As in other developed countries, stroke is a major cause of mortality and morbidity in Australia. For over 10 years there has been evidence favouring organised specialist care in a Stroke Care Unit (SCU) over conventional care. What does this paper add? A conceptual model to address equity of access to SCUs was developed as part of a national program to improve evidence-based stroke care delivery. This paper describes the development process and initial evaluation of the model, identifying areas of potential improvement in the conceptual model, as well as the perceived strengths and barriers related to its implementation from the perspective of health service providers. What are the implications for practice? The Stroke Services Model provides a framework for clinicians to work with one another, within geographical regions, to provide specialist stroke management. The model categories also permit informed health services planning by enabling identification of hospitals that have the resources to potentially provide a dedicated SCU. 