title: Community-based stroke system of care for Chinese rural areas.
abstract: OBJECTIVE
  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 when compared with the control communities, including patients presenting at rural hospitals within 3 hours of symptom onset (13.6% versus 8.7%; P=0.017), diagnosed by computed tomographic scanning within 24 hours of admission (65.3% versus 58.5%; P=0.034), and received thrombolytic treatment (3.9% versus 1.7%; P=0.038). During the 1-year follow-up, 32 (6.5%) patients with stroke in the intervention communities and 48 (10.1%) in the control communities died. The disability rate of stroke was significantly reduced in the intervention communities at postintervention (38.4% versus 48.1%; P=0.001).
  
  
  CONCLUSIONS
  A stroke system of care would be reliable and practical in Chinese rural areas.
  
  
  BACKGROUND
  http://www.chictr.org. Unique identifier: ChiCTR-RCH-13003408.
authors.affiliation: From The First People's Hospital of Lianyungang City, Lianyungang, Jiangsu, China (M.H., N.J., Y.Z.); 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 (J.W., L.G., R.H., Y.W.); Lianyungang City Health Bureau, Lianyungang, Jiangsu, China (Q.D.); Current Cardiovascular Disease Research Center of Lianyungang City, Lianyungang, Jiangsu, China (H.X.); Ganyu County Health Bureau, Ganyu, Jiangsu, China (S.Q.); and The People's Hospital of Ganyu County, Ganyu, Jiangsu, China (H.W., H.Z.).
authors.forename: Mingli
authors.initials: M
authors.lastname: He
authors.affiliation: From The First People's Hospital of Lianyungang City, Lianyungang, Jiangsu, China (M.H., N.J., Y.Z.); 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 (J.W., L.G., R.H., Y.W.); Lianyungang City Health Bureau, Lianyungang, Jiangsu, China (Q.D.); Current Cardiovascular Disease Research Center of Lianyungang City, Lianyungang, Jiangsu, China (H.X.); Ganyu County Health Bureau, Ganyu, Jiangsu, China (S.Q.); and The People's Hospital of Ganyu County, Ganyu, Jiangsu, China (H.W., H.Z.).
authors.forename: Jin'e
authors.initials: J
authors.lastname: Wang
authors.affiliation: From The First People's Hospital of Lianyungang City, Lianyungang, Jiangsu, China (M.H., N.J., Y.Z.); 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 (J.W., L.G., R.H., Y.W.); Lianyungang City Health Bureau, Lianyungang, Jiangsu, China (Q.D.); Current Cardiovascular Disease Research Center of Lianyungang City, Lianyungang, Jiangsu, China (H.X.); Ganyu County Health Bureau, Ganyu, Jiangsu, China (S.Q.); and The People's Hospital of Ganyu County, Ganyu, Jiangsu, China (H.W., H.Z.).
authors.forename: Ling
authors.initials: L
authors.lastname: Gong
authors.affiliation: From The First People's Hospital of Lianyungang City, Lianyungang, Jiangsu, China (M.H., N.J., Y.Z.); 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 (J.W., L.G., R.H., Y.W.); Lianyungang City Health Bureau, Lianyungang, Jiangsu, China (Q.D.); Current Cardiovascular Disease Research Center of Lianyungang City, Lianyungang, Jiangsu, China (H.X.); Ganyu County Health Bureau, Ganyu, Jiangsu, China (S.Q.); and The People's Hospital of Ganyu County, Ganyu, Jiangsu, China (H.W., H.Z.).
authors.forename: Qing
authors.initials: Q
authors.lastname: Dong
authors.affiliation: From The First People's Hospital of Lianyungang City, Lianyungang, Jiangsu, China (M.H., N.J., Y.Z.); 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 (J.W., L.G., R.H., Y.W.); Lianyungang City Health Bureau, Lianyungang, Jiangsu, China (Q.D.); Current Cardiovascular Disease Research Center of Lianyungang City, Lianyungang, Jiangsu, China (H.X.); Ganyu County Health Bureau, Ganyu, Jiangsu, China (S.Q.); and The People's Hospital of Ganyu County, Ganyu, Jiangsu, China (H.W., H.Z.).
authors.forename: Niu
authors.initials: N
authors.lastname: Ji
authors.affiliation: From The First People's Hospital of Lianyungang City, Lianyungang, Jiangsu, China (M.H., N.J., Y.Z.); 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 (J.W., L.G., R.H., Y.W.); Lianyungang City Health Bureau, Lianyungang, Jiangsu, China (Q.D.); Current Cardiovascular Disease Research Center of Lianyungang City, Lianyungang, Jiangsu, China (H.X.); Ganyu County Health Bureau, Ganyu, Jiangsu, China (S.Q.); and The People's Hospital of Ganyu County, Ganyu, Jiangsu, China (H.W., H.Z.).
authors.forename: Houxun
authors.initials: H
authors.lastname: Xing
authors.affiliation: From The First People's Hospital of Lianyungang City, Lianyungang, Jiangsu, China (M.H., N.J., Y.Z.); 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 (J.W., L.G., R.H., Y.W.); Lianyungang City Health Bureau, Lianyungang, Jiangsu, China (Q.D.); Current Cardiovascular Disease Research Center of Lianyungang City, Lianyungang, Jiangsu, China (H.X.); Ganyu County Health Bureau, Ganyu, Jiangsu, China (S.Q.); and The People's Hospital of Ganyu County, Ganyu, Jiangsu, China (H.W., H.Z.).
authors.forename: Yuan
authors.initials: Y
authors.lastname: Zhou
authors.affiliation: From The First People's Hospital of Lianyungang City, Lianyungang, Jiangsu, China (M.H., N.J., Y.Z.); 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 (J.W., L.G., R.H., Y.W.); Lianyungang City Health Bureau, Lianyungang, Jiangsu, China (Q.D.); Current Cardiovascular Disease Research Center of Lianyungang City, Lianyungang, Jiangsu, China (H.X.); Ganyu County Health Bureau, Ganyu, Jiangsu, China (S.Q.); and The People's Hospital of Ganyu County, Ganyu, Jiangsu, China (H.W., H.Z.).
authors.forename: Sizhou
authors.initials: S
authors.lastname: Qin
authors.affiliation: From The First People's Hospital of Lianyungang City, Lianyungang, Jiangsu, China (M.H., N.J., Y.Z.); 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 (J.W., L.G., R.H., Y.W.); Lianyungang City Health Bureau, Lianyungang, Jiangsu, China (Q.D.); Current Cardiovascular Disease Research Center of Lianyungang City, Lianyungang, Jiangsu, China (H.X.); Ganyu County Health Bureau, Ganyu, Jiangsu, China (S.Q.); and The People's Hospital of Ganyu County, Ganyu, Jiangsu, China (H.W., H.Z.).
authors.forename: Huizheng
authors.initials: H
authors.lastname: Wang
authors.affiliation: From The First People's Hospital of Lianyungang City, Lianyungang, Jiangsu, China (M.H., N.J., Y.Z.); 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 (J.W., L.G., R.H., Y.W.); Lianyungang City Health Bureau, Lianyungang, Jiangsu, China (Q.D.); Current Cardiovascular Disease Research Center of Lianyungang City, Lianyungang, Jiangsu, China (H.X.); Ganyu County Health Bureau, Ganyu, Jiangsu, China (S.Q.); and The People's Hospital of Ganyu County, Ganyu, Jiangsu, China (H.W., H.Z.).
authors.forename: Huamin
authors.initials: H
authors.lastname: Zhang
authors.affiliation: From The First People's Hospital of Lianyungang City, Lianyungang, Jiangsu, China (M.H., N.J., Y.Z.); 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 (J.W., L.G., R.H., Y.W.); Lianyungang City Health Bureau, Lianyungang, Jiangsu, China (Q.D.); Current Cardiovascular Disease Research Center of Lianyungang City, Lianyungang, Jiangsu, China (H.X.); Ganyu County Health Bureau, Ganyu, Jiangsu, China (S.Q.); and The People's Hospital of Ganyu County, Ganyu, Jiangsu, China (H.W., H.Z.).
authors.forename: Rutai
authors.initials: R
authors.lastname: Hui
authors.affiliation: From The First People's Hospital of Lianyungang City, Lianyungang, Jiangsu, China (M.H., N.J., Y.Z.); 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 (J.W., L.G., R.H., Y.W.); Lianyungang City Health Bureau, Lianyungang, Jiangsu, China (Q.D.); Current Cardiovascular Disease Research Center of Lianyungang City, Lianyungang, Jiangsu, China (H.X.); Ganyu County Health Bureau, Ganyu, Jiangsu, China (S.Q.); and The People's Hospital of Ganyu County, Ganyu, Jiangsu, China (H.W., H.Z.). yibowang@hotmail.com huirutai@gmail.com.
authors.forename: Yibo
authors.initials: Y
authors.lastname: Wang
mesh_terms: D000368:Aged; D002681:China / Q000453:epidemiology; D019468:Disease Management; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D012424:Rural Population; D020521:Stroke / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy*; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use
chemical_list: D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator
keywords: community knowledge; education; stroke; stroke system