Study objective: To identify the variations between regions in England, Wales and Northern Ireland in the case-mix, organization and process of care for stroke.

Design: Retrospective audit of case notes and service organization.

Setting: Two hundred and ten Trust sites from 197 Trusts in 10 Health Regions in England, Wales and Northern Ireland.

Patients: The 6894 consecutive stroke patients admitted between 1 January and 31 March 1998 (up to 40 per Trust).

Audit tool: The Intercollegiate Stroke Audit.

Results: There are significant differences in stroke care between regions that cannot be explained by known case-mix or clinical variables. The proportion of patients spending more than half their hospital stay in stroke unit care varied between regions from 10% to 27%. Thirty-day mortality in different regions ranged between 21% and 33%. Institutionalization rates for those admitted from home varied between 6% and 19%. Similar variations existed in discharge disability and length of stay.

Conclusions: There were widespread variations in specialist service provision for stroke in different regions. Regional variation in 30-day mortality and in institutionalization after stroke is not explained by clinical factors and therefore may represent different local health care policies and expectations.