Although it is very important to establish an overall, objective evaluation system for assessing the quality of community-based stroke care, there has never been such a system in Japan. To overcome this problem, a research group for “the choice of indicators and the development of audit's system on the community-based stroke care” was organized with the support of a Grant-in-Aid from the Ministry of Health, Labor, and Welfare of Japan. In the United States (US) and Europe, an appropriate evaluation system using clinical indicators has been devised. In the US, the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) conducts a certification of primary stroke centers (PSC) based on recommendations made by the Brain Attack Coalition (BAC). The JCAHO at Oak Brook, Illinois, is an independent, not-for-profit healthcare accrediting organization. We had an opportunity to visit the JCAHO and a primary stroke center of Northwestern Memorial Hospital, Chicago, in December 2006. Northwestern Memorial Hospital is a representative primary stroke center chaired by Professor Mark J. Alberts, a chairman of the BAC. We obtained useful information on evaluation systems for assessing the quality of acute stroke care during this visit. However, the system devised by the JCAHO does not evaluate the quality of the overall community-based stroke care. We should seek to establish a certification and audit system that is unique to our country while referring to that in the US and Europe.