From disease-specific control to system-embedded governance: a multidimensional policy design analysis of stroke...

Stroke remains a major cause of death, disability, and long-term care burden in China. National policy has expanded from disease-specific prevention and treatment to broader arrangements involving chronic disease governance, emergency care, hierarchical services, rehabilitation, and medical quality improvement. However, the policy design and governance structure remain underexamined.

We conducted a multidimensional national policy text analysis of stroke prevention and stroke center development in China. The final corpus comprised 33 national policies issued between 2009 and 2026, including 11 Main policies and 22 Extended policies. Policies were classified by document function, and 1,739 atomic meaning units were coded for policy instruments, governance tasks, strict and contextual actors, policy objects, and policy integration. A stratified sample of 348 units was independently coded, followed by consensus adjudication.

The corpus showed a descriptive three-stage progression from early disease-specific screening and quality-control arrangements, through system expansion, to system-embedded and quality-oriented governance. The final adjudicated dataset contained 16,882 code assignments. Among 5,263 policy-instrument assignments, environment-side instruments accounted for 47.0%, supply-side instruments for 32.2%, and demand-side instruments for 20.7%. Standardized diagnosis, treatment, and acute care was the most frequent governance task, followed by quality improvement, system coordination, and risk-factor control. Hospitals, medical institutions, and stroke centers were the most frequently specified strict actors, while other actor groups showed differentiated task profiles. Policy integration connected stroke governance with medical quality and safety, specialty capacity, chronic disease governance, public health, emergency care, rehabilitation, referral, and financing. Cohen's kappa across the six coding dimensions ranged from 0.595 to 0.746.

China's national stroke policy has evolved toward system-embedded, task-differentiated, and quality-oriented governance. Future policy design may benefit from stronger demand-side and continuity-oriented instruments, clearer cross-setting responsibilities, and closer alignment between stroke-specific policies and wider health-system arrangements.