OBJECTIVE: To determine if the structure of care or the process of stroke care, as measured by compliance with stroke guidelines published by the Agency for Healthcare Research and Quality (AHRQ), is associated with patient satisfaction. DESIGN: Prospective inception cohort study of new stroke admissions including postacute care with follow-up interviews at 6 months poststroke. SETTING: Eleven Veterans Affairs medical centers (VAMCs). PARTICIPANTS: A total of 288 new stroke patients admitted to VAMCs. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Compliance with AHRQ stroke guidelines and patient satisfaction with care using a stroke-specific instrument. RESULTS: Process of care was positively and significantly associated with greater patient satisfaction even after controlling for patient functional outcome. The most visible (to the patient) process of care dimensions correlated most highly with patient satisfaction. Sixty-four percent (73/115) of patients expressed some dissatisfaction with 1 or more survey items. CONCLUSIONS: "What we do" and "how we do it" while providing postacute care to stroke patients was associated with patient satisfaction. This linkage of process to outcome is an important validation of satisfaction as a significant patient outcome. This linkage is further evidence that compliance with AHRQ stroke guidelines may be a valid quality of care indicator.