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Background Stroke prehospital time is exceptionally long in China. The multifaceted Stroke 1-2-0 Amplifying Version Engagement (SAVE) intervention has substantially reduced onset-to-door time for patients with acute stroke in Shanghai, China. However, there is limited evidence regarding the economic impacts of community educational interventions on reducing hospital delays. Therefore, this study aimed to assess the implementation and downstream healthcare costs associated with the educational program. Methods Data were extracted anonymously from the hospital information systems for all ischemic stroke patients admitted to the hospital from 2016 to 2019. Ischemic stroke patients who presented to the hospital within 2 days of stroke were included in the analysis. Cost data from different years were converted into 2019 Chinese Yuan (CNY) using a 5% discount rate based on China Guidelines for Pharmacoeconomic Evaluations. We used a multivariate generalized linear model (GLM) with a log-link to examine the intervention’s impact on length of stay (LOS) and costs. Results The SAVE intervention was estimated to cost CNY 1,768,067 for Xinzhuang County from October 2016 to December 2019. Most costs (59.51%) were for the mass media broadcast. 2,830 stroke patients met the inclusion criteria, including 490 in the pre-SAVE and 2,340 in the post-SAVE period. Following the multifaceted SAVE intervention, the mean (± standardized deviation [SD]) LOS decreased from 9.48 (± 3.80) days to 8.80 (± 3.55) days, representing a reduction of 7.17%. The mean (± SD) hospitalization costs per patient dropped from CNY 21,951 (± 10,411) to CNY 19,263 (± 12,773) ( P  < 0.001), with a 12.25% reduction in hospitalization costs. In the GLM model, the intervention was associated with reduced LOS (β coefficient [95% CI]: -0.070 [-0.11 to -0.030]; P  < 0.001) and hospitalization costs (β coefficient [95% CI]: -0.11 [-0.17 to -0.053]; P  < 0.001). Conclusions Our findings suggest that the SAVE intervention was associated with potential cost-offsets through its effect on reducing LOS and hospitalization costs. To further enhance stroke awareness at the national level, innovative approaches to educational delivery, such as mobile-based platforms and AI-enhanced strategies, represent promising hypotheses that warrant future evaluation.

Background Stroke is one of the leading causes of death worldwide, especially in developing countries. In China, there is an urgent need to educate people about stroke awareness and the importance of using emergency medical services (EMS) quickly after a stroke has occurred. Objective We sought to explore the effects of the Stroke 1-2-0 Prehospital Stroke Education System based on the experience of a general practitioner team. Method We prospectively enrolled 119 community general practitioners to be trained in the procedures advocated by the Stroke 1-2-0 Prehospital Stroke Education System. The training content included early detection of ischemic stroke, first aid for stroke, and intravenous thrombolysis; The effects of the training were later evaluated via a before-and-after comparison. The 119 enrolled physicians formed a Stroke 1-2-0 lecturer group and taught stroke knowledge to community residents. The group remained active for 6 months, during which the medical treatment data of stroke patients (i.e., stroke onset time, prehospital delay, whether an ambulance was called, and whether thrombolytic therapy was performed) in each of 5 jurisdictions were recorded for the month before (January 2021) and that after (August 2021) the 6-month community education program. Finally, the effects of the community education program were evaluated. Results The participants’ understanding of intravenous thrombolysis in the treatment of acute ischemic stroke improved significantly after the training as compared with their earlier understanding (96% vs. 78.99%; P  < .001), and their understanding of the time window for intravenous thrombolysis increased from 26.05% before to 72% ( P  < .001) after the training. Most of the participants (90% vs. 67.23%; P  < .001) said that they would immediately call the 120 emergency number of China’s emergency phone system if they encountered individuals who appeared to be victims of acute stroke. A total of 82 stroke patients were seen before and 67 after the community education program. As for the use of the emergency call system, more patients with stroke activated that system after the program versus before (21.95% vs. 37.31%; P  = .04). The 3-hour arrival rate after the program was nearly three times higher than that before the program (62.69% vs. 19.51%; P  < .001). Also, regarding receiving thrombolysis after the occurrence of a stroke, the program triggered a substantial increase compared with the total earlier (19.4% vs. 6.1%; P  = .013). Conclusion We found that the Stroke 1-2-0 Prehospital Stroke Education System significantly improved community residents’ knowledge regarding stroke.

Background Stroke 1‐2‐0 and FAST (Face, Arm, Speech, Time) are two popular stroke educational tools that have been used in many stroke promotion campaigns. However, few researchers have investigated awareness of these tools among older adults in communities. Methods This study was a cross‐sectional survey of community‐living older adults. Two family physicians conducted face‐to‐face interviews with older adults living in Minhang district, Shanghai, between October 1, 2020 and November 31, 2020. The survey comprised three parts: basic information, prior medical history, and stroke awareness knowledge. We focused on the awareness of FAST and Stroke 1‐2‐0 and investigated factors associated with awareness of these stroke educational tools. Results The sample of this study was 466 older adults. Their mean age was 73.45 years. Male respondents accounted for 46.14% of the total sample. More than half of the older adults surveyed had an educational background of less than 6 years. Over 90% of the older adults surveyed had never heard about Stroke 1‐2‐0 or FAST. The awareness rate of Stroke 1‐2‐0 and FAST was 7.94%, with awareness of Stroke 1‐2‐0 being higher than that of FAST (6.01% vs. 0.43%, p < .05). None of the respondents who had heard about the two stroke educational tools could explain the utility of either tool fully. Having a background in higher education was associated with awareness of stroke educational tools independently, with an odds ratio (OR) of 10.07, 95% confidence interval (CI) of 3.7–27.4, p < .001. In addition, Wechat (OR 6.57, 95%CI 2.65–16.27, p < .001) and the community bulletin board (OR 2.95, 95%CI 1.37–6.33, p = .005) were found to be important sources for acquiring knowledge of stroke awareness tools. Conclusion The limited awareness of Stroke 1‐2‐0 and FAST displayed among older adults in the community indicates that we must take action to improve education on stroke among the elderly.