We define health systems-based interventions CLINICAL STATEMENTS AND GUIDELINES Kleindorfer for secondary stroke prevention as those that influence vascular risk factor treatment and control by influencing provider or patient behaviors. These are often multicom- ponent interventions that fit into categories defined by Wensing et al829 and referenced in a Cochrane review of interventions for secondary stroke prevention.830 Cat- egories include interventions that involve revision of pro- fessional roles, collaboration between multidisciplinary teams, integrated care services, knowledge management systems, and quality management systems. We review best available data here but consider that the generaliz- ability of findings may be affected by the study setting, patient access to care after an acute stroke, and other patient demographic characteristics. Recommendation-Specific Supportive Text 1. Adherence to evidence-based guidelines for secondary stroke prevention is affect by health system level, hospital-level, provider-level, and patient- and community-specific factors. Regular hospital and outpatient-based programs for adher- ence and risk factor monitoring provide the oppor- tunity to identify areas of need and to optimize strategies to improve care quality, improve risk fac- tor control, and ultimately reduce the risk of recur- rent stroke and TIA. The Get With The Guidelines registry is an example of an inpatient registry used for quality monitoring and improvement.831 2. Interventions that include a multidisciplinary team based approach to care may be beneficial for risk factor control and secondary prevention after ischemic stroke and TIA. 