Stroke care in Germany: evidence gaps and priorities for health services research and quality assurance

Abstract Stroke remains one of the leading causes of morbidity and mortality in Germany and worldwide. Within this position paper by the Commission Health Services Research and Quality Assurance of the German Stroke Society, we summarize current data on stroke epidemiology, healthcare delivery, and quality assurance of stroke in Germany, identify evidence and knowledge gaps across the stroke care pathway, and derive priorities for future health services research and quality assurance. Based on registry and routine administrative data, approximately 253,000 incident and recurrent strokes were estimated to occur in Germany in 2023. Although age-standardized stroke mortality rates had declined substantially since the 1980s, this trend has reached a plateau since 2018. Acute care is predominantly administered in certified stroke units, characterized by high process and outcome quality. However, areas for improvement remain in post-acute care and in structured outpatient aftercare, particularly regarding appropriate care for patients with persistent functional impairments and unmet needs. Future research priorities include for example the utilization of real-world data to document long-term outcomes, the expansion of quality assurance to specific entities such as subarachnoid hemorrhage, and the evaluation of telemedical frameworks in pre-hospital settings. Systematic implementation of Patient-Reported Outcome Measures (PROMs) in research and clinical practice could facilitate the identification of unmet needs and the development of patient-centered care models. In light of recent legislative advancements (e.g., the Health Data Use Act, European Health Data Space) and technological innovations (e.g., AI-driven applications), new opportunities are emerging to bolster health services research and further optimize the management of stroke patients.