Integrated Stroke Care Pathway – Stroke 360º: Enhancing Acute Stroke Management and Strengthening Regional Health Governance in São Paulo City, Brazil
1
São Paulo Municipal Health Department (Secretaria Municipal da Saúde de São Paulo), Municipal Government of São Paulo, São Paulo, Brazil
Popul. Med. 2026;8(Supplement Supplement 1):A3055
ABSTRACT
INTRODUCTION:
Stroke remains a leading cause of mortality and disability worldwide. In 2025, it ranked as the second leading cause of death and the third contributor to Disability-Adjusted Life Years (DALYs) globally, imposing significant economic and social burdens, particularly in low- and middle-income countries¹. In Brazil, the Unified Health System (SUS) operates through regionalized care networks jointly managed by national and subnational entities. São Paulo, the largest urban center in the country, provides care to over 11 million residents² through a public health network comprising more than a thousand facilities across all levels of care³.
METHODS:
The initiative was structured around five strategic pillars: (1) enhancing comprehensive care quality across the network; (2) institutionalizing continuous education; (3) reinforcing inter-federative governance; (4) improving information management; and (5) ensuring financial efficiency. Telehealth services were deployed, and professional training sessions were conducted regularly to ensure timely diagnosis and treatment. Care pathways were reorganized across primary, pre-hospital (mobile and fixed), hospital, home, outpatient, and rehabilitation settings to ensure seamless patient transitions throughout the continuum of care.
RESULTS:
A pilot project was completed in a municipal region with over 2.8 million inhabitants² and 24 emergency services³. The program fostered greater coordination between municipal and state health services, trained over 4.500 healthcare professionals, and produced analytical tools for population profiling and clinical outcome mapping. A 40% increase in thrombolysis procedures was observed, reflecting enhanced acute care response. Additionally, municipal hospitals were accredited for federal and state co-financing, ensuring financial sustainability.
CONCLUSIONS:
The multidimensional Stroke 360º approach significantly improved integrated stroke management and reinforced health system governance in São Paulo. Its success demonstrates potential for nationwide scale-up and adaptation to other acute and chronic care pathways, offering a replicable model for strengthening health systems in resource-limited settings.
Stroke remains a leading cause of mortality and disability worldwide. In 2025, it ranked as the second leading cause of death and the third contributor to Disability-Adjusted Life Years (DALYs) globally, imposing significant economic and social burdens, particularly in low- and middle-income countries¹. In Brazil, the Unified Health System (SUS) operates through regionalized care networks jointly managed by national and subnational entities. São Paulo, the largest urban center in the country, provides care to over 11 million residents² through a public health network comprising more than a thousand facilities across all levels of care³.
METHODS:
The initiative was structured around five strategic pillars: (1) enhancing comprehensive care quality across the network; (2) institutionalizing continuous education; (3) reinforcing inter-federative governance; (4) improving information management; and (5) ensuring financial efficiency. Telehealth services were deployed, and professional training sessions were conducted regularly to ensure timely diagnosis and treatment. Care pathways were reorganized across primary, pre-hospital (mobile and fixed), hospital, home, outpatient, and rehabilitation settings to ensure seamless patient transitions throughout the continuum of care.
RESULTS:
A pilot project was completed in a municipal region with over 2.8 million inhabitants² and 24 emergency services³. The program fostered greater coordination between municipal and state health services, trained over 4.500 healthcare professionals, and produced analytical tools for population profiling and clinical outcome mapping. A 40% increase in thrombolysis procedures was observed, reflecting enhanced acute care response. Additionally, municipal hospitals were accredited for federal and state co-financing, ensuring financial sustainability.
CONCLUSIONS:
The multidimensional Stroke 360º approach significantly improved integrated stroke management and reinforced health system governance in São Paulo. Its success demonstrates potential for nationwide scale-up and adaptation to other acute and chronic care pathways, offering a replicable model for strengthening health systems in resource-limited settings.
| eISSN: | 2654-1459 |
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