Leadership to Improve Rural Stroke Care: From Policy to Practice

Stroke outcomes are shaped not only by biology, but by geography, health systems, workforce capacity, and public policy. For people living in rural and remote communities, these interacting forces determine whether effective stroke prevention, acute treatment, rehabilitation, and long-term recovery are available when needed. Despite major advances in reperfusion therapies and stroke systems of care, large disparities persist across countries and within countries, with rural populations continuing to experience delayed diagnosis, reduced access to specialised care, and poorer outcomes.This Research Topic seeks to move the field beyond describing disparities toward identifying actionable solutions that are economically viable and fiscally responsible. The focus is leadership: leadership in clinical practice, service organisation, health policy, digital innovation, and community engagement. We aim to bring together evidence that addresses the full continuum of rural stroke care, from prevention and prehospital pathways to acute treatment, rehabilitation, secondary prevention, and long-term support.The collection welcomes studies that examine rural stroke care as a complex adaptive system in which biological urgency interacts with healthcare infrastructure and social context. This perspective aligns with the “Time-Tissue-Systems” framework introduced by Sonu Bhaskar, which conceptualises stroke outcomes as the product of dynamic interactions between time-dependent tissue injury and the capacity of healthcare systems to deliver timely, effective care across the continuum of disease (Bhaskar, 2026, JCNSD). In rural settings, strengthening systems — and doing so in a fiscally responsible way that makes the most of limited resources — is often as important as advancing therapies.We are particularly interested in research that generates transferable, replicable insights. This includes rural stroke networks, telestroke and digital health, mobile stroke units, implementation science, artificial intelligence, workforce development, Indigenous and underserved populations, equitable access to reperfusion therapies, and policy innovations that improve care in low-resource settings. We especially welcome work that demonstrates how economically viable, fiscally responsible models can be scaled and replicated across regions and health systems. Comparative analyses across countries and health systems are strongly encouraged.The ultimate goal of this collection is pragmatic. We seek evidence that can inform policy, improve clinical practice, and guide fiscally responsible investment in resilient stroke systems that deliver high-quality care regardless of geography. By integrating perspectives from clinicians, researchers, policymakers, health service leaders, and patient advocates, this Research Topic aims to establish a practical, replicable roadmap for reducing inequities and improving stroke outcomes worldwide — one that helps direct funding to where it can help the most people.*Bhaskar S. Beyond Time Is Brain: The Time, Tissue, and Systems Framework for Acute Stroke. J. Cent. Nerv. Syst. Dis. (2026)Topics of Interesto Rural and remote stroke systems of careo Stroke policy, governance and health system reformo Telestroke, digital health and artificial intelligenceo Prehospital care and transfer pathwayso Mobile stroke units and imaging accesso Workforce development and leadershipo Health equity, Indigenous health and underserved populationso Implementation science and economic evaluationo Rehabilitation and long-term stroke careo Global and low-resource perspectiveso Cost-effectiveness, fiscal sustainability and replicable models of rural stroke care Topic editors: Prof Sonu Bhaskar, Tim Putnam Source: https://www.frontiersin.org/research-topics/82928/leadership-to-improve-rural-stroke-care-from-policy-to-practice