COR LOE Recommendations In patients with ischemic stroke or TIA, voluntary hospital-based or outpatient-focused quality monitoring and improvement programs are recommended to improve short-term and long-term adherence to nationally accepted, evidence-based guidelines for secondary stroke prevention. In patients with ischemic stroke or TIA, a mul- tidisciplinary outpatient team-based approach (ie, care provision with active medication adjust- ment from advanced practice providers, nurses, or pharmacists) can be effective to control BP, lipids, and other vascular risk factors.810 817 In patients presenting to their primary care provider as the first contact after TIA or minor stroke, it is reasonable to use a decision sup- port tool that improves diagnostic accuracy, stratifies patients in risk categories to support appropriate triage, and prompts the initiation of medications and counseling for lifestyle modification for secondary stroke prevention to reduce the 90-day risk of recurrent stroke Synopsis Optimal treatment recommendations exist for many stroke risk factors. However, treatment targets are often unmet after ischemic stroke and TIA, thereby increasing the risk of recurrent events.819 825 Health system approaches to acute stroke management have transformed care delivery and have led to improved access to stroke treatment and improved stroke outcomes.826 828 Similar approaches to poststroke care and secondary prevention hold promise for improving risk factor control after stroke.829 Risk factor control is affected by patient, provider, and system-level factors. 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. 