The Economic Impact of the Multifaceted Stroke 1-2-0 Educational Campaign in China

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Lu, Yang Liu, Renyu Liu, Jing Zhao This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4912045/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 10 Mar, 2026 Read the published version in BMC Health Services Research → Version 1 posted 4 You are reading this latest preprint version Abstract 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. 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. Cost data from different years were converted into 2019 Chinese Yuan (CNY) using a 5% discount rate. We used a multivariate generalized linear model (GLM) with log-link to examine the campaign's impact on 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 (59.64%) were for the mass media broadcast. 2830 stroke patients met the inclusion criteria, including 490 in the pre-campaign and 2,340 in the post-campaign period. Following the multifaceted SAVE intervention, the mean (SD) LOS decreased from 9.48 (3.80) days to 8.80 (3.55) days. The mean (SD) hospitalization costs per patient dropped from ¥21950.72 (10410.74) to ¥19262.50 (12772.81) CNY (P < .01). In the GLM model, the campaign was associated with reduced LOS (Table; β coefficient [95% CI]: -0.070 [-0.11 to -0.030]; P < 0.01) and hospitalization costs (β coefficient [95% CI]: -0.11 [-0.17 to -0.053]; P < 0.01). Conclusions Our findings suggest that the SAVE intervention generated economic savings through its effect on reducing LOS, which could be explained by improved intravenous thrombolytic therapy. Innovative ways of delivering educational materials, e.g., via digital health, will need to be explored by lowering costs for personnel and mass media. Figures Figure 1 Figure 2 Figure 3 Main text Stroke remains a leading cause of death globally; it is also ranked as the number one cause of death and disability in some low- and middle-income countries (LMICs), particularly in China. 1 Stroke death and disability are attributable to two primary barriers: failure to identify and failure to rescue. 2 Reperfusion therapy by intravenous thrombolysis or endovascular mechanical thrombectomy improves the likelihood of disability-free recovery after acute ischemic stroke (AIS) but should be initiated within 6 hours of stroke onset. 3 ,4 5 The use of reperfusion therapy remains very low (< 10%) in China, partly due to poor awareness and significant prehospital delay, many people are disabled or even die without receiving any time-sensitive reperfusion therapy. 6 – 8 Recent data indicated that the median stroke onset-to-door time was around 24 hours in China. Super long stroke onset-to-door delay should be considered a global crisis, especially in LMICs. 8 Hence, reducing prehospital delay by improving layperson’s symptom recognition is urgently needed. 9 , 10 To improve stroke knowledge, the Stroke 1-2-0 tool was developed to help laypersons identify stroke warning signs, by adapting FAST to the local emergency phone number of 1-2-0 in China. 11 The community-based educational campaigns are an important strategy to promote stroke recognition tools and shorten the prehospital time in some high-income countries. Still, such programs are scarcely available in LMICs. 12 To promote the Stroke 1-2-0 tool, we designed a multilevel educational program entitled “ S troke 1-2-0 A mplifying V ersion E ngagement ( SAVE )”, which aims to encourage immediate action when any stroke symptoms occur and improve stroke outcomes in China. 13 In the pilot study covering Xinzhuang County of Shanghai, the SAVE intervention demonstrated promising effectiveness in reducing prehospital time. 14 However, limited data is available on the implementation costs and their downstream healthcare costs, further impedes the adoption of health educational programs. 12 Hence, this study aimed to fill gaps in the literature by comprehensively assessing the costs and resources needed to develop and execute the stroke educational program in China. This study also evaluated the economic impacts of SAVE intervention on healthcare utilization and costs. Methods Study design The effects of the SAVE intervention, in terms of the 3-hour hospital arrival rate, have been published elsewhere. 14 Following the previously published study, 14 data were extracted anonymously from the hospital information systems for all ischemic stroke patients admitted to the hospital from January 1, 2016, to December 31, 2019. 14 The SAVE intervention was implemented on October 1, 2016; the pre-campaign period was defined as January 2016 to September 2016 and the post-campaign period was from defined as November 2016 to December 2019. This study followed the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines for cohort studies. 15 Ethics approval This study was reviewed and approved by the ethics committees of the Institutional Review Boards of Minhang Hospital of Fudan University. Overview of Save Intervention The SAVE intervention was introduced to Xinzhuang, Shanghai using a multifaceted outreach campaign implementation strategy, including broadcasting videos, printed materials, local news, and face-to-face community education, which has been reported elsewhere. 14 In brief, the SAVE intervention included: (1) The television campaign ran through free media advertising on the local TV Channel. The one-minute animated video, which was endorsed by the Chinese Stroke Association (CSA), 16 was broadcast six times per day. (2) The radio campaign ran through free radio advertising on the local station. The radio advertisement was broadcast six times per day. (3) The newspaper advertised the Stroke 1-2-0 pictures in the local newspaper. (4) The public poster campaign distributed 30,000 brochures to residents each year. (5) face-to-face education sessions were offered by primary physicians every week. Sample selection As described previously, 14 AIS patients who met the following criteria were included in the analysis: 1) diagnosed with ischemic stroke, which was confirmed with computed tomography or magnetic resonance image; 2) hospital admission within two days of stroke onset; and 3) lived in Xinzhuang during the campaign. Patients were excluded if they 1) had stroke onset within hospitals; 2) had dementia or psychological disorders; 3) had missing data on demographics, NIHSS score, date and time of symptom onset, and length and cost of hospital stay. Healthcare utilization and costs The relative difference in length of stay (LOS) and costs for AIS patients admitted to the hospital in pre- and post-SAVE was used to determine the potential impacts of SAVE intervention on healthcare utilization and cost. 17 The LOS and costs were estimated as the mean LOS and total hospitalization costs per admission due to AIS. We retrieved the sum of the costs for each AIS patient admitted to the hospital, including nursing, medical services, laboratory tests, and prescription drugs. Because the use of intravenous thrombolytic therapy was significantly improved following the SAVE intervention, the costs for intravenous thrombolytic therapy were not included in the analysis. Cost of SAVE intervention To measure the implementation cost of SAVE, we employed a micro-costing approach to quantify the resources needed to develop and implement the SAVE programs, following the recommendation for economic evaluations for implementation studies. 18 – 20 From the healthcare system's perspective, direct cost data were collected for October 2016-December 2019. We quantified the quantity and unit cost from logistical and expenditure reports, further clarified by discussions with project staff and physicians. Total intervention costs included personnel costs (e.g., salary, benefits), travel, materials (e.g., posters), facilities, and campaign costs (e.g., planning, designing and executing media). The advertising fees, whether donated or subsidized by local communities, were based on fair market value. We used the average annual income in Shanghai for personnel costs, with an additional 40% fringe benefit rate. The annual income was obtained from the National Burau of Statistics. 21 For in-person educational sessions, 50 volunteer physicians were recruited and provided in-person educational sessions. The travel and training time for providing in-person educational sessions were based on the average income for full-time equivalent (FTE) healthcare providers. We also recruited ten project staff to distribute posters, brochures, and management (e.g., scheduling educational sessions). We used the average salary for community workers for project staff. Travel costs were determined from staff time and transportation modes. Statistical analysis Continuous variables are presented with mean and standard deviation (SD) and compared with student t-tests. Categorical variables are reported with frequencies and percentages and compared with chi-square tests. We also compared the length and hospital stay costs before and after the SAVE intervention. We employed a generalized linear model with a gamma distribution and log link to calculate the mean incremental effect of SAVE on LOS and total hospital costs after adjustment for potential confounders, including age, sex, stroke severity, cigarette smoking, alcohol drinking, prior history ischemic stroke or TIA, comorbidities. All analyses were conducted using SAS 9.4. Two-sided P < 0.05 was considered statistically significant. Cost data from different years were converted into the 2019 Chinese Yuan (CNY) using a 5% inflation rate. Results Patient characteristics From January 1 2016 to December 31 2019, among the 4,432 AIS patients who were admitted to the Minhang hospital, 137 patients were excluded because they had missing data on the stroke onset time or hospital arrival time, 43 patients were excluded because they had stroke onset while in hospital, 27 patients were excluded because they had dementia or psychological disorders, and 1,395 patients were excluded because they had missing data on costs or NIHSS score. Therefore, a total of 2,830 patients with stroke were included in the analysis. The flowchart of the sample selection process is shown in Fig. 1 . A total of 2,830 AIS patients were included in the analysis. 490 stroke patients were included in the pre-campaign period and 2,340 stroke patients were included in the post-campaign period. As shown in Table 1 , there were no statistically significant differences in age (P = 0.577), sex (P = 0.093), alcohol drinking (P = 0.056), prior history of ischemic stroke or TIA (P = 0.076), the onset of stroke during the daytime (P = 0.064), and comorbidities between AIS patients in the pre-and post-campaign periods. Compared to the pre-campaign period, the post-campaign period had a higher proportion of AIS patients who had a mild stroke (75.64% vs 65.10%; P < .001). Table 1 Characteristics of stroke patients in pre-campaign and post-campaign period Characteristics Pre-campaign Post-campaign P -value (n = 490) (n = 2,340) Age, years 0.577 18–44 13 (2.65%) 81 (3.46%) 45–64 155 (31.63%) 685 (29.27%) 65–75 137 (27.96%) 695 (29.70%) 75+ 185 (37.76%) 879 (37.56%) Sex 0.093 Female 202 (41.22%) 870 (37.18%) Male 288 (58.78%) 1470 (62.82%) Stroke severity < .001 1 ≤ NIHSS ≤ 4 319 (65.10%) 1770 (75.64%) 5 ≤ NIHSS ≤ 14 149 (30.41%) 525 (22.44%) NIHSS ≥ 15 22 (4.49%) 45 (1.92%) Cigarette smoker 122 (24.90%) 620 (26.50%) < .001 Alcohol drinker 59 (12.04%) 216 (9.23%) 0.056 Prior stroke or TIA 107 (21.84%) 430 (18.38%) 0.076 Medical conditions Hypertension 328 (66.94%) 1473 (62.95%) 0.095 Diabetes mellitus 134 (27.35%) 658 (28.12%) 0.729 CH&SH 11 (2.24%) 58 (2.48%) 0.760 Atrial Fibrillation 44 (8.98%) 156 (6.67%) 0.069 Daytime onset 356 (72.65%) 1602 (68.46%) 0.036 Abbreviation: SD , standard deviation; TIA, Transient ischemic attack; CH , cerebral hemorrhage; SH , subarachnoid hemorrhage; NIHSS , National Institutes of Health Stroke Scale; PVD , Peripheral Vascular Disease. Daytime was defined as 6AM to 6 PM; tPA : Tissue plasminogen Activator. Cost of SAVE intervention The SAVE intervention was estimated to cost ¥1,768,067 CNY for Xinzhuang County from October 2016 to December 2019, with ¥516,453 CNY in 2017, ¥519,316 CNY in 2018, and ¥523,526 CNY in 2019 (Table 2 ). As shown in Fig. 2 , most of the costs (59.64%) were for the mass media broadcast, including the advertising fee for local newspapers, TV, and radio stations. Other major cost drivers included the costs for personnel and travel (26.01%) and materials (6.70%). Table 2 Implementation costs (CNY) of SAVE intervention* Cost category Implementation activity 2016 (Oct-Dec) 2017 (Jan-Dec) 2018 (Jan-Dec) 2019 (Jan-Dec) Program activities Training by experts 5,325 5,072 4,830 4,600 Physician trainee expense 1,458 1,503 1,548 1,568 Project staff/coordinator trainee expense 886 853 858 861 Planning for implementation 53,251 — — — Facilities and equipment rental 892 910 879 949 Materials Brochures 7,380 29,768 29,925 31,500 Posters 1,476 5,954 5,985 6,300 Personnel and travel In-person education by physicians 3,790 15,626 16,098 15,985 Poster/brochure distribution by project staffs 27,929 107,572 108,202 108,529 Transportation 1,655 5,833 6,224 6,240 Management by project coordinators 2,793 10,757 10,820 10,853 Mass media New advertisement 1,968 7,938 7,980 8,000 Television broadcast 49,199 198,450 199,500 200,000 Video Production 9,840 9,923 9,975 10,000 Radio broadcast 24,600 99,225 99,750 100,000 Audio Production 3,936 3,969 3,990 4,000 Facilities Facilities and equipment rental 12,395 13,101 12,751 14,140 Total : 208,772 516,453 519,316 523,526 *Cost data were converted into 2019 Chinese Yuan (CNY) using a 5% inflation rate. Healthcare utilization and costs The mean (SD) LOS after the SAVE intervention was significantly shorter at 8.80 (3.55) days in the post-SAVE period compared to 9.48 (3.80) days in the pre-SAVE period (Fig. 3 ; P < .001). In the GLM model, the SAVE intervention was associated with reduced LOS (Table 3 ; β coefficient [95% CI]: -0.070 [-0.11 to -0.030]; P < 0.01). The adjusted incremental reduction in LOS was 0.69 days per hospital admission. Table 3 Adjusted length and cost of hospitalization for ischemic stroke Characteristics Length of Stay Hospitalization Costs LSM Adjusted β (95% CI) P-value LSM Adjusted β (95% CI) P-value Stroke 1-2-0 campaign Yes 2.25 -0.070 (-0.11 to -0.030) < .01 9.98 -0.11 (-0.17 to -0.053) < .01 No 2.32 0 [Reference] — 10.10 0 [Reference] — Age 18–44 2.21 0 [Reference] — 9.98 0 [Reference] — 45–64 2.26 0.048 (-0.044 to 0.14) 0.303 10.05 0.074 (-0.066 to 0.21) 0.302 65–75 2.31 0.097 (0.005 to 0.19) 0.040 10.12 0.14 (0.001 to 0.28) 0.049 75+ 2.35 0.13 (0.042 to 0.23) < .01 10.01 0.036 (-0.11 to 0.18) 0.624 Sex Male 2.30 0 [Reference] — 10.11 0 [Reference] — Female 2.27 -0.038 (-0.070 to -0.006) 0.019 9.97 -0.14 (-0.19 to -0.089) < .01 Stroke severity 1 < NIHSS ≤ 4 2.12 0 [Reference] — 9.80 0 [Reference] — 5 < NIHSS ≤ 14 2.27 0.28 (0.21 to 0.36) < .01 9.98 0.18 (0.13 to 0.23) 15 2.40 0.23 (0.16 to 0.30) < .01 10.45 0.65 (0.55 to 0.75) < .01 Cigarette smoker 2.28 -0.002 (-0.036 to 0.033) 0.919 10.02 0.047 (-0.052 to 0.10) 0.078 Alcohol drinker 2.28 0.004 (-0.048 to 0.056) 0.877 10.01 0.061 (-0.018 to 0.14) 0.132 Prior stroke or TIA 2.26 -0.043 (-0.081 to -0.005) 0.028 10.09 -0.091 (-0.15 to -0.030) 0.003 Medical conditions Hypertension 2.28 -0.012 (-0.044 to 0.020) 0.446 10.07 -0.070 (-0.12 to -0.021) < .01 Diabetes mellitus 2.30 0.032 (-0.001 to 0.065) 0.055 10.01 0.052 (0.009 to 0.10) 0.046 Atrial Fibrillation 2.28 -0.001 (-0.056 to 0.055) 0.984 10.03 0.024 (-0.062 to 0.11) 0.578 Daytime onset 2.28 -0.013 (-0.044 to 0.018) 0.416 10.02 0.030 (-0.018 to 0.078) 0.213 Abbreviation: TIA , Transient ischemic attack; NIHSS , National Institutes of Health Stroke Scale. Daytime was defined as 6 AM to 6 PM. The mean (SD) hospitalization costs per admission dropped from ¥21950.72 (10410.74) to ¥19262.50 (12772.81) CNY (P < .01). In the GLM model, the SAVE intervention was associated with lower hospitalization costs (β coefficient [95% CI]: -0.11 [-0.17 to -0.053]; P < 0.01). The adjusted incremental reduction in hospitalization costs was ¥2,604 CNY per hospital admission. Discussion Our findings suggest that the SAVE intervention generated economic benefits through its effect on reducing LOS, which could be explained by improved intravenous thrombolytic therapy for stroke patients. 14 In addition, with shorter prehospital delay, stroke patients were less likely to have neurological deficits upon hospital admission, and hence, fewer healthcare resources were needed. Stroke educational campaigns effectively improve stroke knowledge and promote behavioural changes, but they generally require large, sustained funding. 10 , 12 Policymakers face challenges in balancing the rising healthcare burden with implementing educational campaigns. However, to our knowledge, few studies examined the economic impact of educational campaigns. 22 Hence, our analysis provided crucial empirical evidence for future work that scales up the intervention in other regions of China. This study provides important evidence on the cost of implementing the community-based campaign in China. On average, the annual cost of implementing the SAVE intervention was around ¥500,000 CNY in Shanghai, China. The advertising fees for mass media (e.g., newspaper, radio, and TV) were the major cost drivers, but these costs were donated by the local community. In addition, more than 25% of the total intervention cost was for personnel and travel, including salary and benefits. Even though physicians and project staff worked as volunteers, their personnel costs were also included in the analysis to obtain a more conservative estimate. Our analysis also demonstrated the economic impacts of implementing the SAVE intervention. On average, the SAVE intervention was associated substantial reduction in hospitalization costs. In the post-campaign period, a total of 2,340 stroke patients were admitted to hospitals. With the ¥2,604 CNY estimated reduction in hospitalization costs per admission, the reduction in hospitalization costs is projected to be ¥6,093,360 CNY post-campaign period. At the same time, the total implementation costs of SAVE intervention are only ¥1,768,067 CNY during the same period. Hence, the estimated cost-savings were expected to be more than 4 million CNY for Xinzhuang, Shanghai. With over 2.4 million incident stroke cases annually across China, one of the savings in hospitalization would be more substantial if successfully implementing the educational campaign nationwide. Furthermore, considering the improved functional independence of stroke survivors, the educational campaign would have even more profound economic implications by reducing caregiver and society burdens. Although Stroke recognition tools (e.g., F.A.S.T.) have been shown to improve stroke awareness, stroke early detection, and reduce prehospital delay for stroke 23 – 27 , the effects of education campaigns were not sustainable, particularly after the COVID-19 pandemic. In fact, the United Kingdom relaunched the FAST campaign to reduce stroke burden in 2022 because of the prolonged prehospital time. 28 A potential explanation is due to the lack of effective and sustainable intervention strategies that are customized for different populations and settings. 29 Mass media campaigns are expensive, and their effects on behaviour change are still unknown. 10 Traditional educational campaigns also require enormous resources for implementation, which is challenging for LMICs like China. Even though our findings suggested that the implementation costs could offset the implementation costs, it is still unknown whether the economic benefits are persistent over the long run. With the recent advancement in digital technology, therefore, innovative digital health education strategies should be developed to deliver digital media and digital products for stroke education. The current SAVE campaign is a community-based campaign, without targeting those at risk for stroke. Innovative strategies should be also developed to deliver interventions specific to those with higher risks of stroke. This study has several strengths. First, this is the first empirical study in China to determine the implementation and downstream costs of educational campaigns in China, providing important evidence for future scaling up. The cost-effectiveness of mass media campaigns is a concern, and our study demonstrated that a well-designed educational campaign could reduce hospitalization costs and achieve potential cost-savings. Second, our study also categorized implementation costs into traditional categories, which will assist in planning future implementation strategies. For example, mass media and personnel are the main cost drivers, and digital health strategies should explored in future implementation studies. This study has some limitations. First, the study only collected data from one hospital, the findings may not be generalizable to other settings. Second, the shorten in LOS may contribute to other factors, e.g., the healthcare reforms that limit the length of hospitalization. Therefore, future studies could employ a prospective study design with a control group (e.g., a randomized control trial). Third, the personnel costs were estimated based on the average salary rather than the actual salary earned by physicians and project staff. Conclusion Our findings suggest that the Stroke 1-2-0 campaign generated economic savings through its effect on reducing LOS, which could be explained by improved intravenous thrombolytic therapy. Innovative ways of delivering educational materials, e.g., via mobile App, will need to be explored by lowering costs for personnel and mass media. Declarations Ethics approval and consent to participate: This study was reviewed and approved by the ethics committees of the Institutional Review Boards of Minhang Hospital of Fudan University. The requirement for written informed consent from participants was waived by the Shanghai Ethics Committee for Clinical Research. Consent for publication: Not applicable. Availability of data and materials: The datasets used and/or analyzed during the present study are available from the corresponding author upon reasonable request. Competing interests: The authors declare that there are no conflicts of interest. Funding: Not applicable Authors' contributions: JY: conceptualization, methodology, formal analysis, writing original draft, and review & editing manuscript; YW: conceptualization, methodology, formal analysis, writing original draft, and review & editing manuscript; YL: review & editing manuscript; ZKL: review & editing manuscript; RL: review & editing manuscript; JZ: conceptualization, methodology, supervision, funding acquisition, project administration, and review & editing manuscript. Acknowledgement: We acknowledge the community volunteers and the doctors of the community hospital for promoting the Stroke 1-2-0 educational program in Minhang District. References Wu S, Wu B, Liu M, et al. Stroke in China: advances and challenges in epidemiology, prevention, and management. Lancet Neurol . Apr 2019;18(4):394-405. doi:10.1016/s1474-4422(18)30500-3 Schroeder EB, Rosamond WD, Morris DL, Evenson KR, Hinn AR. 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Implementing evidence-based interventions in health care: application of the replicating effective programs framework. Implement Sci . Dec 9 2007;2:42. doi:10.1186/1748-5908-2-42 Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 10 Mar, 2026 Read the published version in BMC Health Services Research → Version 1 posted Editorial decision: Revision requested 19 Aug, 2024 Editor assigned by journal 18 Aug, 2024 Submission checks completed at journal 18 Aug, 2024 First submitted to journal 14 Aug, 2024 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4912045","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":342053427,"identity":"670fa5f5-711e-4f3f-a17f-5b5f96ebe01b","order_by":0,"name":"Jing Yuan","email":"","orcid":"","institution":"Minhang Hospital, Fudan University","correspondingAuthor":false,"prefix":"","firstName":"Jing","middleName":"","lastName":"Yuan","suffix":""},{"id":342053428,"identity":"6ecd0043-2595-4dbe-a26e-de40a0dae634","order_by":1,"name":"Yong Wang","email":"","orcid":"","institution":"Fudan University","correspondingAuthor":false,"prefix":"","firstName":"Yong","middleName":"","lastName":"Wang","suffix":""},{"id":342053429,"identity":"cca6ecd8-616c-4dbc-8506-f42c1c33c6f0","order_by":2,"name":"Kevin Z. Lu","email":"","orcid":"","institution":"University of South Carolina","correspondingAuthor":false,"prefix":"","firstName":"Kevin","middleName":"Z.","lastName":"Lu","suffix":""},{"id":342053430,"identity":"059975a3-2b74-4872-821b-56c1d7f0d65c","order_by":3,"name":"Yang Liu","email":"","orcid":"","institution":"Fudan University","correspondingAuthor":false,"prefix":"","firstName":"Yang","middleName":"","lastName":"Liu","suffix":""},{"id":342053431,"identity":"82b2dece-75fc-478e-b740-db153bf89fae","order_by":4,"name":"Renyu Liu","email":"","orcid":"","institution":"University of Pennsylvania","correspondingAuthor":false,"prefix":"","firstName":"Renyu","middleName":"","lastName":"Liu","suffix":""},{"id":342053432,"identity":"f626566f-a883-4ae1-8d3e-a614d3c53893","order_by":5,"name":"Jing Zhao","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA9UlEQVRIiWNgGAWjYDACCRDBAyTZGx8w8ICFEojVwnPYgBQtYEYykVrkZzc/fMAgY5EnH/mYTeJNzR0GfvYcA4afO3BrYZxzzBhoukSx4e1kNsk5x54xSPa8MWDsPYNbC7NEgpkEUEvixtn5x6R52A4zGNzIMWBmbMOthU0i/RtEy8zDbNI8/w4z2BPSwiORA7FlvgQzmzRvG9AWCQJaJCRyikF+SdzAk8xsObfvMI/EmWcFB3vxaJGfkb7xAWNPXeL89sOMN958OyzH35688cFPPFrAQfC3h4HB4ADUpSDiAH4NIPADaF0DYWWjYBSMglEwQgEAtjZIAzxCYGEAAAAASUVORK5CYII=","orcid":"","institution":"Fudan University","correspondingAuthor":true,"prefix":"","firstName":"Jing","middleName":"","lastName":"Zhao","suffix":""}],"badges":[],"createdAt":"2024-08-14 08:32:53","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4912045/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4912045/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12913-026-14191-0","type":"published","date":"2026-03-10T16:00:30+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":66564213,"identity":"8dfb6415-c900-4d0d-a06b-4ce54ad8ce74","added_by":"auto","created_at":"2024-10-14 10:35:19","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":108979,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eFlowchart of sample selection\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"Figure1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-4912045/v1/a019f1861428dc7b07ae1b12.jpg"},{"id":66564215,"identity":"e171d4c7-ed56-4047-8820-3c7158e014b3","added_by":"auto","created_at":"2024-10-14 10:35:19","extension":"jpg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":132333,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eLength and costs of hospital in pre- and post-SAVE intervention\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"Figure2.jpg","url":"https://assets-eu.researchsquare.com/files/rs-4912045/v1/9ed688fe7a727da79eb4e5c3.jpg"},{"id":66564217,"identity":"0729bfbc-7833-4acb-9e65-36200724b848","added_by":"auto","created_at":"2024-10-14 10:35:19","extension":"jpg","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":35039,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eImplementation costs of SAVE intervention\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"Figure3.jpg","url":"https://assets-eu.researchsquare.com/files/rs-4912045/v1/60d57df66e087b24222f2402.jpg"},{"id":104740272,"identity":"4973b360-e9ef-4c2e-848c-5681621ceec0","added_by":"auto","created_at":"2026-03-16 16:16:18","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1480063,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4912045/v1/fed4d991-f470-4721-b76b-1e3cb64f09a7.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"The Economic Impact of the Multifaceted Stroke 1-2-0 Educational Campaign in China","fulltext":[{"header":"Main text","content":"\u003cp\u003eStroke remains a leading cause of death globally; it is also ranked as the number one cause of death and disability in some low- and middle-income countries (LMICs), particularly in China.\u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u003c/sup\u003e Stroke death and disability are attributable to two primary barriers: failure to identify and failure to rescue.\u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003e Reperfusion therapy by intravenous thrombolysis or endovascular mechanical thrombectomy improves the likelihood of disability-free recovery after acute ischemic stroke (AIS) but should be initiated within 6 hours of stroke onset.\u003csup\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e,4 5\u003c/sup\u003e The use of reperfusion therapy remains very low (\u0026lt;\u0026thinsp;10%) in China, partly due to poor awareness and significant prehospital delay, many people are disabled or even die without receiving any time-sensitive reperfusion therapy.\u003csup\u003e\u003cspan additionalcitationids=\"CR7\" citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u003c/sup\u003e Recent data indicated that the median stroke onset-to-door time was around 24 hours in China. Super long stroke onset-to-door delay should be considered a global crisis, especially in LMICs.\u003csup\u003e\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u003c/sup\u003e Hence, reducing prehospital delay by improving layperson\u0026rsquo;s symptom recognition is urgently needed.\u003csup\u003e\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e,\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u003c/sup\u003e To improve stroke knowledge, the Stroke 1-2-0 tool was developed to help laypersons identify stroke warning signs, by adapting FAST to the local emergency phone number of 1-2-0 in China.\u003csup\u003e\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eThe community-based educational campaigns are an important strategy to promote stroke recognition tools and shorten the prehospital time in some high-income countries. Still, such programs are scarcely available in LMICs.\u003csup\u003e\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u003c/sup\u003e To promote the Stroke 1-2-0 tool, we designed a multilevel educational program entitled \u0026ldquo;\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eS\u003c/span\u003etroke 1-2-0 \u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eA\u003c/span\u003emplifying \u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eV\u003c/span\u003eersion \u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eE\u003c/span\u003engagement (\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eSAVE\u003c/span\u003e)\u0026rdquo;, which aims to encourage immediate action when any stroke symptoms occur and improve stroke outcomes in China.\u003csup\u003e\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u003c/sup\u003e In the pilot study covering Xinzhuang County of Shanghai, the SAVE intervention demonstrated promising effectiveness in reducing prehospital time.\u003csup\u003e\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u003c/sup\u003e However, limited data is available on the implementation costs and their downstream healthcare costs, further impedes the adoption of health educational programs.\u003csup\u003e\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u003c/sup\u003e Hence, this study aimed to fill gaps in the literature by comprehensively assessing the costs and resources needed to develop and execute the stroke educational program in China. This study also evaluated the economic impacts of SAVE intervention on healthcare utilization and costs.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy design\u003c/h2\u003e \u003cp\u003eThe effects of the SAVE intervention, in terms of the 3-hour hospital arrival rate, have been published elsewhere.\u003csup\u003e\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u003c/sup\u003e Following the previously published study,\u003csup\u003e\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u003c/sup\u003e data were extracted anonymously from the hospital information systems for all ischemic stroke patients admitted to the hospital from January 1, 2016, to December 31, 2019.\u003csup\u003e\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u003c/sup\u003e The SAVE intervention was implemented on October 1, 2016; the pre-campaign period was defined as January 2016 to September 2016 and the post-campaign period was from defined as November 2016 to December 2019. This study followed the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines for cohort studies.\u003csup\u003e\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eEthics approval\u003c/h2\u003e \u003cp\u003e This study was reviewed and approved by the ethics committees of the Institutional Review Boards of Minhang Hospital of Fudan University.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eOverview of Save Intervention\u003c/h2\u003e \u003cp\u003eThe SAVE intervention was introduced to Xinzhuang, Shanghai using a multifaceted outreach campaign implementation strategy, including broadcasting videos, printed materials, local news, and face-to-face community education, which has been reported elsewhere.\u003csup\u003e\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u003c/sup\u003e In brief, the SAVE intervention included: (1) The television campaign ran through free media advertising on the local TV Channel. The one-minute animated video, which was endorsed by the Chinese Stroke Association (CSA),\u003csup\u003e\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u003c/sup\u003e was broadcast six times per day. (2) The radio campaign ran through free radio advertising on the local station. The radio advertisement was broadcast six times per day. (3) The newspaper advertised the Stroke 1-2-0 pictures in the local newspaper. (4) The public poster campaign distributed 30,000 brochures to residents each year. (5) face-to-face education sessions were offered by primary physicians every week.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eSample selection\u003c/h2\u003e \u003cp\u003eAs described previously,\u003csup\u003e\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u003c/sup\u003e AIS patients who met the following criteria were included in the analysis: 1) diagnosed with ischemic stroke, which was confirmed with computed tomography or magnetic resonance image; 2) hospital admission within two days of stroke onset; and 3) lived in Xinzhuang during the campaign. Patients were excluded if they 1) had stroke onset within hospitals; 2) had dementia or psychological disorders; 3) had missing data on demographics, NIHSS score, date and time of symptom onset, and length and cost of hospital stay.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eHealthcare utilization and costs\u003c/h2\u003e \u003cp\u003eThe relative difference in length of stay (LOS) and costs for AIS patients admitted to the hospital in pre- and post-SAVE was used to determine the potential impacts of SAVE intervention on healthcare utilization and cost.\u003csup\u003e\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u003c/sup\u003e The LOS and costs were estimated as the mean LOS and total hospitalization costs per admission due to AIS. We retrieved the sum of the costs for each AIS patient admitted to the hospital, including nursing, medical services, laboratory tests, and prescription drugs. Because the use of intravenous thrombolytic therapy was significantly improved following the SAVE intervention, the costs for intravenous thrombolytic therapy were not included in the analysis.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eCost of SAVE intervention\u003c/h2\u003e \u003cp\u003eTo measure the implementation cost of SAVE, we employed a micro-costing approach to quantify the resources needed to develop and implement the SAVE programs, following the recommendation for economic evaluations for implementation studies.\u003csup\u003e\u003cspan additionalcitationids=\"CR19\" citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e\u003c/sup\u003e From the healthcare system's perspective, direct cost data were collected for October 2016-December 2019. We quantified the quantity and unit cost from logistical and expenditure reports, further clarified by discussions with project staff and physicians. Total intervention costs included personnel costs (e.g., salary, benefits), travel, materials (e.g., posters), facilities, and campaign costs (e.g., planning, designing and executing media). The advertising fees, whether donated or subsidized by local communities, were based on fair market value.\u003c/p\u003e \u003cp\u003eWe used the average annual income in Shanghai for personnel costs, with an additional 40% fringe benefit rate. The annual income was obtained from the National Burau of Statistics.\u003csup\u003e\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e\u003c/sup\u003e For in-person educational sessions, 50 volunteer physicians were recruited and provided in-person educational sessions. The travel and training time for providing in-person educational sessions were based on the average income for full-time equivalent (FTE) healthcare providers. We also recruited ten project staff to distribute posters, brochures, and management (e.g., scheduling educational sessions). We used the average salary for community workers for project staff. Travel costs were determined from staff time and transportation modes.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003eStatistical analysis\u003c/h2\u003e \u003cp\u003eContinuous variables are presented with mean and standard deviation (SD) and compared with student t-tests. Categorical variables are reported with frequencies and percentages and compared with chi-square tests. We also compared the length and hospital stay costs before and after the SAVE intervention. We employed a generalized linear model with a gamma distribution and log link to calculate the mean incremental effect of SAVE on LOS and total hospital costs after adjustment for potential confounders, including age, sex, stroke severity, cigarette smoking, alcohol drinking, prior history ischemic stroke or TIA, comorbidities. All analyses were conducted using SAS 9.4. Two-sided P\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was considered statistically significant. Cost data from different years were converted into the 2019 Chinese Yuan (CNY) using a 5% inflation rate.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003ePatient characteristics\u003c/h2\u003e \u003cp\u003eFrom January 1 2016 to December 31 2019, among the 4,432 AIS patients who were admitted to the Minhang hospital, 137 patients were excluded because they had missing data on the stroke onset time or hospital arrival time, 43 patients were excluded because they had stroke onset while in hospital, 27 patients were excluded because they had dementia or psychological disorders, and 1,395 patients were excluded because they had missing data on costs or NIHSS score. Therefore, a total of 2,830 patients with stroke were included in the analysis. The flowchart of the sample selection process is shown in Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eA total of 2,830 AIS patients were included in the analysis. 490 stroke patients were included in the pre-campaign period and 2,340 stroke patients were included in the post-campaign period. As shown in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e, there were no statistically significant differences in age (P\u0026thinsp;=\u0026thinsp;0.577), sex (P\u0026thinsp;=\u0026thinsp;0.093), alcohol drinking (P\u0026thinsp;=\u0026thinsp;0.056), prior history of ischemic stroke or TIA (P\u0026thinsp;=\u0026thinsp;0.076), the onset of stroke during the daytime (P\u0026thinsp;=\u0026thinsp;0.064), and comorbidities between AIS patients in the pre-and post-campaign periods. Compared to the pre-campaign period, the post-campaign period had a higher proportion of AIS patients who had a mild stroke (75.64% vs 65.10%; P\u0026thinsp;\u0026lt;\u0026thinsp;.001).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eCharacteristics of stroke patients in pre-campaign and post-campaign period\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCharacteristics\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePre-campaign\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePost-campaign\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;490)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;2,340)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAge, years\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.577\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e18\u0026ndash;44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e13 (2.65%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e81 (3.46%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e45\u0026ndash;64\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e155 (31.63%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e685 (29.27%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e65\u0026ndash;75\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e137 (27.96%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e695 (29.70%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e75+\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e185 (37.76%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e879 (37.56%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSex\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.093\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e202 (41.22%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e870 (37.18%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e288 (58.78%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1470 (62.82%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eStroke severity\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1\u0026thinsp;\u0026le;\u0026thinsp;NIHSS\u0026thinsp;\u0026le;\u0026thinsp;4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e319 (65.10%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1770 (75.64%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e5\u0026thinsp;\u0026le;\u0026thinsp;NIHSS\u0026thinsp;\u0026le;\u0026thinsp;14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e149 (30.41%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e525 (22.44%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNIHSS\u0026thinsp;\u0026ge;\u0026thinsp;15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e22 (4.49%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e45 (1.92%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eCigarette smoker\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e122 (24.90%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e620 (26.50%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAlcohol drinker\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e59 (12.04%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e216 (9.23%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.056\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePrior stroke or TIA\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e107 (21.84%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e430 (18.38%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.076\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMedical conditions\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHypertension\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e328 (66.94%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1473 (62.95%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.095\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDiabetes mellitus\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e134 (27.35%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e658 (28.12%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.729\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCH\u0026amp;SH\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e11 (2.24%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e58 (2.48%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.760\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAtrial Fibrillation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e44 (8.98%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e156 (6.67%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.069\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eDaytime onset\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e356 (72.65%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1602 (68.46%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.036\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAbbreviation: SD\u003c/b\u003e, standard deviation; TIA, Transient ischemic attack; \u003cb\u003eCH\u003c/b\u003e, cerebral hemorrhage; \u003cb\u003eSH\u003c/b\u003e, subarachnoid hemorrhage; \u003cb\u003eNIHSS\u003c/b\u003e, National Institutes of Health Stroke Scale; \u003cb\u003ePVD\u003c/b\u003e, Peripheral Vascular Disease. Daytime was defined as 6AM to 6 PM; \u003cb\u003etPA\u003c/b\u003e: Tissue plasminogen Activator.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eCost of SAVE intervention\u003c/h2\u003e \u003cp\u003eThe SAVE intervention was estimated to cost \u0026yen;1,768,067 CNY for Xinzhuang County from October 2016 to December 2019, with \u0026yen;516,453 CNY in 2017, \u0026yen;519,316 CNY in 2018, and \u0026yen;523,526 CNY in 2019 (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). As shown in Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e, most of the costs (59.64%) were for the mass media broadcast, including the advertising fee for local newspapers, TV, and radio stations. Other major cost drivers included the costs for personnel and travel (26.01%) and materials (6.70%).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eImplementation costs (CNY) of SAVE intervention*\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCost category\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eImplementation activity\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2016\u003c/p\u003e \u003cp\u003e(Oct-Dec)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2017\u003c/p\u003e \u003cp\u003e(Jan-Dec)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2018\u003c/p\u003e \u003cp\u003e(Jan-Dec)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2019\u003c/p\u003e \u003cp\u003e(Jan-Dec)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003e\u003cb\u003eProgram activities\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTraining by experts\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5,325\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5,072\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4,830\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e4,600\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePhysician trainee expense\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1,458\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1,503\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1,548\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1,568\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eProject staff/coordinator trainee expense\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e886\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e853\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e858\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e861\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePlanning for implementation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e53,251\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFacilities and equipment rental\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e892\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e910\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e879\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e949\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMaterials\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBrochures\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7,380\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e29,768\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e29,925\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e31,500\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePosters\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1,476\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5,954\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e5,985\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e6,300\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e\u003cb\u003ePersonnel and travel\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIn-person education by physicians\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3,790\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e15,626\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e16,098\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e15,985\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePoster/brochure distribution by project staffs\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e27,929\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e107,572\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e108,202\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e108,529\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTransportation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1,655\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5,833\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e6,224\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e6,240\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eManagement by project coordinators\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2,793\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e10,757\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e10,820\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e10,853\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003e\u003cb\u003eMass media\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNew advertisement\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1,968\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7,938\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e7,980\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e8,000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTelevision broadcast\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e49,199\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e198,450\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e199,500\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e200,000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eVideo Production\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9,840\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e9,923\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e9,975\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e10,000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRadio broadcast\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e24,600\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e99,225\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e99,750\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e100,000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAudio Production\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3,936\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3,969\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3,990\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e4,000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eFacilities\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFacilities and equipment rental\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12,395\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e13,101\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e12,751\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e14,140\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eTotal\u003c/b\u003e:\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e208,772\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e516,453\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e519,316\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e523,526\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003e*Cost data were converted into 2019 Chinese Yuan (CNY) using a 5% inflation rate.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eHealthcare utilization and costs\u003c/h2\u003e \u003cp\u003eThe mean (SD) LOS after the SAVE intervention was significantly shorter at 8.80 (3.55) days in the post-SAVE period compared to 9.48 (3.80) days in the pre-SAVE period (Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e; P\u0026thinsp;\u0026lt;\u0026thinsp;.001). In the GLM model, the SAVE intervention was associated with reduced LOS (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e; β coefficient [95% CI]: -0.070 [-0.11 to -0.030]; P\u0026thinsp;\u0026lt;\u0026thinsp;0.01). The adjusted incremental reduction in LOS was 0.69 days per hospital admission.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eAdjusted length and cost of hospitalization for ischemic stroke\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"8\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eCharacteristics\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003eLength of Stay\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c8\" namest=\"c6\"\u003e \u003cp\u003eHospitalization Costs\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLSM\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAdjusted β (95% CI)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eP-value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eLSM\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eAdjusted β (95% CI)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003eP-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStroke 1-2-0 campaign\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e2.25\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e-0.070 (-0.11 to -0.030)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;.01\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e9.98\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e-0.11 (-0.17 to -0.053)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;.01\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0 [Reference]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e\u0026mdash;\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e10.10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0 [Reference]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003cb\u003e\u0026mdash;\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAge\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e18\u0026ndash;44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0 [Reference]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e\u0026mdash;\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e9.98\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0 [Reference]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003cb\u003e\u0026mdash;\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e45\u0026ndash;64\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.048 (-0.044 to 0.14)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.303\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e10.05\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.074 (-0.066 to 0.21)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.302\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e65\u0026ndash;75\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.097 (0.005 to 0.19)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.040\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e10.12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.14 (0.001 to 0.28)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003cb\u003e0.049\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e75+\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.13 (0.042 to 0.23)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;.01\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e10.01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.036 (-0.11 to 0.18)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.624\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSex\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0 [Reference]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e\u0026mdash;\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e10.11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0 [Reference]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003cb\u003e\u0026mdash;\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-0.038 (-0.070 to -0.006)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.019\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e9.97\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-0.14 (-0.19 to -0.089)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;.01\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eStroke severity\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1\u0026thinsp;\u0026lt;\u0026thinsp;NIHSS\u0026thinsp;\u0026le;\u0026thinsp;4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0 [Reference]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e\u0026mdash;\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e9.80\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0 [Reference]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003cb\u003e\u0026mdash;\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e5\u0026thinsp;\u0026lt;\u0026thinsp;NIHSS\u0026thinsp;\u0026le;\u0026thinsp;14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.28 (0.21 to 0.36)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;.01\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e9.98\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.18 (0.13 to 0.23)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;.01\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNIHSS\u0026thinsp;\u0026gt;\u0026thinsp;15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.23 (0.16 to 0.30)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;.01\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e10.45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.65 (0.55 to 0.75)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;.01\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eCigarette smoker\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-0.002 (-0.036 to 0.033)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.919\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e10.02\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.047 (-0.052 to 0.10)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.078\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAlcohol drinker\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.004 (-0.048 to 0.056)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.877\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e10.01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.061 (-0.018 to 0.14)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.132\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePrior stroke or TIA\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-0.043 (-0.081 to -0.005)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.028\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e10.09\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-0.091 (-0.15 to -0.030)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003cb\u003e0.003\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMedical conditions\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHypertension\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-0.012 (-0.044 to 0.020)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.446\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e10.07\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-0.070 (-0.12 to -0.021)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;.01\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDiabetes mellitus\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.032 (-0.001 to 0.065)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.055\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e10.01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.052 (0.009 to 0.10)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003cb\u003e0.046\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAtrial Fibrillation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-0.001 (-0.056 to 0.055)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.984\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e10.03\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.024 (-0.062 to 0.11)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.578\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eDaytime onset\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-0.013 (-0.044 to 0.018)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.416\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e10.02\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.030 (-0.018 to 0.078)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.213\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"8\" nameend=\"c8\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAbbreviation: TIA\u003c/b\u003e, Transient ischemic attack; \u003cb\u003eNIHSS\u003c/b\u003e, National Institutes of Health Stroke Scale.\u003c/p\u003e \u003cp\u003eDaytime was defined as 6 AM to 6 PM.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThe mean (SD) hospitalization costs per admission dropped from \u0026yen;21950.72 (10410.74) to \u0026yen;19262.50 (12772.81) CNY (P\u0026thinsp;\u0026lt;\u0026thinsp;.01). In the GLM model, the SAVE intervention was associated with lower hospitalization costs (β coefficient [95% CI]: -0.11 [-0.17 to -0.053]; P\u0026thinsp;\u0026lt;\u0026thinsp;0.01). The adjusted incremental reduction in hospitalization costs was \u0026yen;2,604 CNY per hospital admission.\u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eOur findings suggest that the SAVE intervention generated economic benefits through its effect on reducing LOS, which could be explained by improved intravenous thrombolytic therapy for stroke patients.\u003csup\u003e\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u003c/sup\u003e In addition, with shorter prehospital delay, stroke patients were less likely to have neurological deficits upon hospital admission, and hence, fewer healthcare resources were needed. Stroke educational campaigns effectively improve stroke knowledge and promote behavioural changes, but they generally require large, sustained funding.\u003csup\u003e\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e,\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u003c/sup\u003e Policymakers face challenges in balancing the rising healthcare burden with implementing educational campaigns. However, to our knowledge, few studies examined the economic impact of educational campaigns.\u003csup\u003e\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e\u003c/sup\u003e Hence, our analysis provided crucial empirical evidence for future work that scales up the intervention in other regions of China.\u003c/p\u003e \u003cp\u003eThis study provides important evidence on the cost of implementing the community-based campaign in China. On average, the annual cost of implementing the SAVE intervention was around \u0026yen;500,000 CNY in Shanghai, China. The advertising fees for mass media (e.g., newspaper, radio, and TV) were the major cost drivers, but these costs were donated by the local community. In addition, more than 25% of the total intervention cost was for personnel and travel, including salary and benefits. Even though physicians and project staff worked as volunteers, their personnel costs were also included in the analysis to obtain a more conservative estimate.\u003c/p\u003e \u003cp\u003eOur analysis also demonstrated the economic impacts of implementing the SAVE intervention. On average, the SAVE intervention was associated substantial reduction in hospitalization costs. In the post-campaign period, a total of 2,340 stroke patients were admitted to hospitals. With the \u0026yen;2,604 CNY estimated reduction in hospitalization costs per admission, the reduction in hospitalization costs is projected to be \u0026yen;6,093,360 CNY post-campaign period. At the same time, the total implementation costs of SAVE intervention are only \u0026yen;1,768,067 CNY during the same period. Hence, the estimated cost-savings were expected to be more than 4\u0026nbsp;million CNY for Xinzhuang, Shanghai. With over 2.4\u0026nbsp;million incident stroke cases annually across China, one of the savings in hospitalization would be more substantial if successfully implementing the educational campaign nationwide. Furthermore, considering the improved functional independence of stroke survivors, the educational campaign would have even more profound economic implications by reducing caregiver and society burdens.\u003c/p\u003e \u003cp\u003eAlthough Stroke recognition tools (e.g., F.A.S.T.) have been shown to improve stroke awareness, stroke early detection, and reduce prehospital delay for stroke\u003csup\u003e\u003cspan additionalcitationids=\"CR24 CR25 CR26\" citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e\u003c/sup\u003e, the effects of education campaigns were not sustainable, particularly after the COVID-19 pandemic. In fact, the United Kingdom relaunched the FAST campaign to reduce stroke burden in 2022 because of the prolonged prehospital time.\u003csup\u003e\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e\u003c/sup\u003e A potential explanation is due to the lack of effective and sustainable intervention strategies that are customized for different populations and settings.\u003csup\u003e\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e\u003c/sup\u003e Mass media campaigns are expensive, and their effects on behaviour change are still unknown.\u003csup\u003e\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u003c/sup\u003e Traditional educational campaigns also require enormous resources for implementation, which is challenging for LMICs like China. Even though our findings suggested that the implementation costs could offset the implementation costs, it is still unknown whether the economic benefits are persistent over the long run. With the recent advancement in digital technology, therefore, innovative digital health education strategies should be developed to deliver digital media and digital products for stroke education. The current SAVE campaign is a community-based campaign, without targeting those at risk for stroke. Innovative strategies should be also developed to deliver interventions specific to those with higher risks of stroke.\u003c/p\u003e \u003cp\u003eThis study has several strengths. First, this is the first empirical study in China to determine the implementation and downstream costs of educational campaigns in China, providing important evidence for future scaling up. The cost-effectiveness of mass media campaigns is a concern, and our study demonstrated that a well-designed educational campaign could reduce hospitalization costs and achieve potential cost-savings. Second, our study also categorized implementation costs into traditional categories, which will assist in planning future implementation strategies. For example, mass media and personnel are the main cost drivers, and digital health strategies should explored in future implementation studies.\u003c/p\u003e \u003cp\u003eThis study has some limitations. First, the study only collected data from one hospital, the findings may not be generalizable to other settings. Second, the shorten in LOS may contribute to other factors, e.g., the healthcare reforms that limit the length of hospitalization. Therefore, future studies could employ a prospective study design with a control group (e.g., a randomized control trial). Third, the personnel costs were estimated based on the average salary rather than the actual salary earned by physicians and project staff.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eOur findings suggest that the Stroke 1-2-0 campaign generated economic savings through its effect on reducing LOS, which could be explained by improved intravenous thrombolytic therapy. Innovative ways of delivering educational materials, e.g., via mobile App, will need to be explored by lowering costs for personnel and mass media.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003e\u003cem\u003eEthics approval and consent to participate:\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was reviewed and approved by the ethics committees of the Institutional Review Boards of Minhang Hospital of Fudan University. The requirement for written informed consent from participants was waived by the Shanghai Ethics Committee for Clinical Research.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eConsent for publication:\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eAvailability of data and materials:\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets used and/or analyzed during the present study are available from the corresponding author upon reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eCompeting interests:\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that there are no conflicts of interest.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eFunding:\u003cbr\u003e\u0026nbsp;\u003c/em\u003e\u003c/strong\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eAuthors\u0026apos; contributions:\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eJY: conceptualization, methodology, formal analysis, writing original draft, and review \u0026amp; editing manuscript; YW: conceptualization, methodology, formal analysis, writing original draft, and review \u0026amp; editing manuscript; YL: review \u0026amp; editing manuscript; ZKL: review \u0026amp; editing manuscript; RL: review \u0026amp; editing manuscript; JZ: conceptualization, methodology, supervision, funding acquisition, project administration, and review \u0026amp; editing manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eAcknowledgement:\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe acknowledge the community volunteers and the doctors of the community hospital for promoting the Stroke 1-2-0 educational program in Minhang District.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eWu S, Wu B, Liu M, et al. 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Stroke Warning Information and Faster Treatment (SWIFT): Cost-Effectiveness of a Stroke Preparedness Intervention. \u003cem\u003eValue in Health\u003c/em\u003e. 2019/11/01/ 2019;22(11):1240-1247. doi:https://doi.org/10.1016/j.jval.2019.06.003\u003c/li\u003e\n\u003cli\u003eWall HK, Beagan BM, O\u0026apos;Neill J, Foell KM, Boddie-Willis CL. Addressing stroke signs and symptoms through public education: the Stroke Heroes Act FAST campaign. \u003cem\u003ePrev Chronic Dis\u003c/em\u003e. Apr 2008;5(2):A49.\u003c/li\u003e\n\u003cli\u003eFlynn D, Ford GA, Rodgers H, Price C, Steen N, Thomson RG. A time series evaluation of the FAST National Stroke Awareness Campaign in England. \u003cem\u003ePLoS One\u003c/em\u003e. 2014;9(8):e104289. doi:10.1371/journal.pone.0104289\u003c/li\u003e\n\u003cli\u003eMorimoto A, Miyamatsu N, Okamura T, et al. Effects of intensive and moderate public education on knowledge of early stroke symptoms among a Japanese population: the Acquisition of Stroke Knowledge study. \u003cem\u003eStroke\u003c/em\u003e. Oct 2013;44(10):2829-34. doi:10.1161/strokeaha.113.001537\u003c/li\u003e\n\u003cli\u003eAddo J, Ayis S, Leon J, Rudd AG, McKevitt C, Wolfe CD. Delay in presentation after an acute stroke in a multiethnic population in South london: the South london stroke register. \u003cem\u003eJ Am Heart Assoc\u003c/em\u003e. Jun 2012;1(3):e001685. doi:10.1161/jaha.112.001685\u003c/li\u003e\n\u003cli\u003eOostema JA, Chassee T, Baer W, Edberg A, Reeves MJ. Brief Educational Intervention Improves Emergency Medical Services Stroke Recognition. \u003cem\u003eStroke\u003c/em\u003e. May 2019;50(5):1193-1200. doi:10.1161/strokeaha.118.023885\u003c/li\u003e\n\u003cli\u003eRelaunch of the Act FAST campaign to improve stroke outcomes. https://www.gov.uk/government/news/relaunch-of-the-act-fast-campaign-to-improve-stroke-outcomes\u003c/li\u003e\n\u003cli\u003eKilbourne AM, Neumann MS, Pincus HA, Bauer MS, Stall R. Implementing evidence-based interventions in health care: application of the replicating effective programs framework. \u003cem\u003eImplement Sci\u003c/em\u003e. Dec 9 2007;2:42. doi:10.1186/1748-5908-2-42\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-health-services-research","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bhsr","sideBox":"Learn more about [BMC Health Services Research](http://bmchealthservres.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/BHSR/default.aspx","title":"BMC Health Services Research","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"","lastPublishedDoi":"10.21203/rs.3.rs-4912045/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4912045/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eStroke 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. This study aimed to assess the implementation and downstream healthcare costs associated with the educational program.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eData were extracted anonymously from the hospital information systems for all ischemic stroke patients admitted to the hospital from 2016 to 2019. Cost data from different years were converted into 2019 Chinese Yuan (CNY) using a 5% discount rate. We used a multivariate generalized linear model (GLM) with log-link to examine the campaign's impact on LOS and costs.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eThe SAVE intervention was estimated to cost CNY 1,768,067 for Xinzhuang County from October 2016 to December 2019. Most costs (59.64%) were for the mass media broadcast. 2830 stroke patients met the inclusion criteria, including 490 in the pre-campaign and 2,340 in the post-campaign period. Following the multifaceted SAVE intervention, the mean (SD) LOS decreased from 9.48 (3.80) days to 8.80 (3.55) days. The mean (SD) hospitalization costs per patient dropped from \u0026yen;21950.72 (10410.74) to \u0026yen;19262.50 (12772.81) CNY (P\u0026thinsp;\u0026lt;\u0026thinsp;.01). In the GLM model, the campaign was associated with reduced LOS (Table; β coefficient [95% CI]: -0.070 [-0.11 to -0.030]; P\u0026thinsp;\u0026lt;\u0026thinsp;0.01) and hospitalization costs (β coefficient [95% CI]: -0.11 [-0.17 to -0.053]; P\u0026thinsp;\u0026lt;\u0026thinsp;0.01).\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eOur findings suggest that the SAVE intervention generated economic savings through its effect on reducing LOS, which could be explained by improved intravenous thrombolytic therapy. Innovative ways of delivering educational materials, e.g., via digital health, will need to be explored by lowering costs for personnel and mass media.\u003c/p\u003e","manuscriptTitle":"The Economic Impact of the Multifaceted Stroke 1-2-0 Educational Campaign in China","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-10-14 10:35:14","doi":"10.21203/rs.3.rs-4912045/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2024-08-19T10:01:59+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-08-19T02:50:49+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-08-19T02:49:47+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Health Services Research","date":"2024-08-14T08:31:23+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-health-services-research","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bhsr","sideBox":"Learn more about [BMC Health Services Research](http://bmchealthservres.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/BHSR/default.aspx","title":"BMC Health Services Research","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"6d8bceed-ebe2-4017-a977-d84b6ba02af3","owner":[],"postedDate":"October 14th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2026-03-16T16:11:31+00:00","versionOfRecord":{"articleIdentity":"rs-4912045","link":"https://doi.org/10.1186/s12913-026-14191-0","journal":{"identity":"bmc-health-services-research","isVorOnly":false,"title":"BMC Health Services Research"},"publishedOn":"2026-03-10 16:00:30","publishedOnDateReadable":"March 10th, 2026"},"versionCreatedAt":"2024-10-14 10:35:14","video":"","vorDoi":"10.1186/s12913-026-14191-0","vorDoiUrl":"https://doi.org/10.1186/s12913-026-14191-0","workflowStages":[]},"version":"v1","identity":"rs-4912045","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4912045","identity":"rs-4912045","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}