The goals of stroke care are to reduce the incidence of, and illness and death from, stroke while improving quality of life for stroke survivors. Stroke systems of care coordinate and promote access to optimal care from the identification, reduction, and treatment of risk factors through prevention of recurrent stroke and rehabilitation; promote changes in hospital policies and systems to improve delivery of care; and ultimately improve patient outcomes. Traditionally public health has not focused on quality of care (QoC) for acute events of a chronic disease, such as stroke. Yet, through the core functions of public health — assessment, policy development, and assurance (1) — state health departments are uniquely positioned to foster quality improvement (QI) for care of stroke and heart disease patients. State health departments’ expertise in surveillance can be used for QoC and QI activities, enabling them to translate research into programs that assess and improve QoC for stroke patients, resulting in development of necessary components of stroke systems of care, and ultimately ensuring patient access to high-quality stroke care.