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Background: Stroke is the 4th leading cause of death in Illinois and the leading cause of disability. In 2009, Illinois passed stroke legislation to establish a Stroke Advisory Sub-committee to advise the State EMS Advisory Council. Legislation also created 11 multidisciplinary EMS Regional Stroke Advisory Subcommittees, recognition of certified Primary Stroke Centers, state designation of Emergent Stroke Ready hospitals and updating of EMS routing protocols. In 2014, updated legislation was passed to include state recognition of nationally certified Comprehensive Stroke Centers (CSC), updating of EMS routing protocols to include CSC’s and establish a state stroke fund created from hospital designation fees.Hypothesis: Implementation of Illinois’s stroke legislation by EMS region enhances systems of care collaboration between hospitals and EMS providers and improves timely intervention for patients with acute ischemic stroke.Methods: We queried the state-wide AHA’s Get With The Guideline stroke registry, which captured 72% of Illinois stroke discharges from 2009 through 2015. In total, 90 hospitals entered data, 57 from PSCs, 8 from CSCs, and 25 from Emergent Stroke Ready hospitals. All patients included in the registry as confirmed stroke were included for analysis. Hospital time and treatment data were recorded in an aggregate manner. Descriptive statistics were used to report results.Results: The total number of confirmed stroke patients treated was 123,859 Median door-to-needle (DTN) times for IV tPA therapy went from 85 minutes in 2009 to 56 in 2015 . The percent of acute ischemic stroke patients with a door-to-needle time of 60 minutes or less increased from 18.0% in 2009 to 62.9% in 2015.Conclusions: The decrease in DTN from 2009 to 2015 is an indicator of improved care due to the Illinois stroke system of care model. This is a good example of all system stakeholders including state government and EMS working collaboratively to improve care. Which elements of a stroke system are responsible for this improvement (hospital designation, routing, EMS training) will require further research. Regional coordination of resources and state hospital designation may impact prehospital routing of suspected strokes and may improve patient outcomes.