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Community-based stroke system of care improves patient outcomes in Chinese rural areas
  1. Mingli He1,
  2. Jin’e Wang2,
  3. Qing Dong3,
  4. Niu Ji1,
  5. Pin Meng1,
  6. Na Liu1,
  7. Shan Geng1,
  8. Sizhou Qin4,
  9. Wenyan Xu4,
  10. Chuantong Zhang4,
  11. Dabo Li5,
  12. Huamin Zhang5,
  13. Jinping Zhu5,
  14. Hua Qin5,
  15. Rutai Hui6,
  16. Yibo Wang6
  1. 1 The First People’s Hospital of Lianyungang City, Lianyungang, China
  2. 2 College of Medical Science, China Three Gorges University, Yichang, China
  3. 3 Lianyungang City Commission of Health and Family Planning, Lianyungang, China
  4. 4 Ganyu County Commission of Health and Family Planning, Ganyu, China
  5. 5 The People’s Hospital of Ganyu County, Ganyu, China
  6. 6 State Key Laboratory of Cardiovascular Disease, Sino-German Laboratory for Molecular Medicine, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
  1. Correspondence to Professor Yibo Wang, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences, Beijing 100037, China; yibowang{at}


Background Building effective and efficient stroke care systems is a key step in improving prevention, treatment and rehabilitation of stroke. The aim of this study was to evaluate the effectiveness of this stroke system of care on stroke management during a 2-year follow-up.

Methods A stroke system of care was developed from November 2009 to November 2010 in three townships in Ganyu County. Additional three matched townships were invited as controls. We first investigated the stroke incidence of these populations. Subsequently, this stroke system of care and an educational campaign in the three intervention townships were implemented and the effectiveness of the system was evaluated in the next 2 years.

Results At postintervention, more patients in the intervention communities obtained stroke knowledge and then the proportion of patients with stroke who were admitted within 3 hours of onset markedly increased in 2012 (12.0% vs 8.1%, p=0.044) and in 2013 (15.2% vs 9.7%, p=0.008) compared with those in the control communities. In the intervention communities, this proportion of patients with acute ischaemic stroke who received thrombolytic treatment was markedly raised from 2.1% in 2012 to 3.0% in 2013. More importantly, the fatality rate substantially decreased in 2013 in the intervention communities compared with that in the control communities (6.1% vs 9.7%, p=0.032). Similarly, the disability rate significantly decreased in 2013 (45.3% vs 51.5%, p=0.045).

Conclusions The community-based stroke system of care was effective and practical for optimising stroke treatments and improving patient outcomes.

Trial registration number ChiCTR-RCH-13003408, Post-results.

  • stroke system of care
  • rural areas
  • intervention
  • new stroke

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  • MH and J’W contributed equally.

  • Contributors YW designed the paper. MH, QD, NJ, PM, NL, SG, SQ, WX, CZ, DL, HZ, JZ, HQ and RH carried out the literature search, data collection and selection. MH and JW provided the analysis and interpretation. JW wrote the drafts. All authors read and approved the final manuscript.

  • Funding The study was supported by the Health Bureau of Jiangsu Province with grant H10509 to MH, the Ministry of Science and Technology of China with grant 2017YFC0909403 and 973 2012CB517804 to YW, and the National Natural Science Foundation of China with grants 81770424 and 81322002 to YW.

  • Disclaimer The views expressed in the submitted article are of the authors and not an official position of the institution or funder.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Ethics approval The Ethics Committee of the First People’s Hospital of Lianyungang City.

  • Provenance and peer review Not commissioned; externally peer reviewed.