The management model of the stroke system of care in rural communities

n developing China, the annual stroke mortality rate is ≈116/100 000 in cities and 111/100 000 in rural areas, which has surpassed heart disease to become the leading cause of adult death. 1 In addition, China has 2.5 million new stroke cases each year and 7.5 million stroke survivors. 2 Recently, a 21-year observational study from the Sino-MONICA-Beijing Project reported that the incidence rate of hemorrhagic stroke declined by 1.7%, and the incidence rate of ischemic stroke increased by 8.7% annually on average. 3 Thus, the rising incidence and effect of stroke have created a huge burden on the Chinese healthcare system. 2,4 In 2005, the American Stroke Association's Task Force made recommendations for the establishment of stroke systems of care to optimize patient care and management processes, as well as improve patient outcomes. 5 A fully functional stroke system of care would reduce stroke-related deaths by 2% to 3% annually. 6 Poststroke disability would also be reduced, which would improve the quality of life and reduce the burden on patients, their families, and governments. 6 In Europe, the Helsingborg Declaration of 2006 set new targets on the overall aims and goals of 5 aspects of stroke management (organization of stroke services, management of acute stroke, prevention , rehabilitation, and evaluation of stroke outcome and quality assessment) to be achieved by 2015. 7 Of all patients with stroke in Europe, 39.4% were admitted to a stroke unit, 8 which is the key basic measure of stroke service quality. The Background and Purpose—Stroke system of care plays key roles both in providing effective therapies and in improving the overall outcome of patients with stroke. Our purpose was to develop and evaluate the system in Chinese rural areas. Methods—A stroke system of care was developed from November 2009 to November 2010 in 3 townships in Ganyu County. An additional 3 matched townships were invited as controls. We first investigated stroke management in these townships and then implemented stroke system of care and an education campaign in the 3 intervention townships. The effectiveness of the system was then evaluated. Results—There were 1036 patients with new stroke among 344 345 subjects in the 6 rural communities. The incidence of stroke in the rural areas was 301/100 000, and the mortality rate was 55/100 000. The proportions significantly increased in the intervention communities after the implementation of the stroke system of care and education campaign …