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Background: The Minnesota Stroke System is comprised of hospitals able to deliver state-of-the-art stroke treatment. The system is designed to increase access to acute stroke treatment and improve outcomes for stroke patients. Between 2011 and 2013, the Minnesota Department of Health convened health care providers and stroke patient advocates to plan and create the components of a statewide stroke system for Minnesota. To launch the system, the Minnesota legislature gave MDH statutory authorization to designate Acute Stroke Ready Hospitals (ASRHs) and recognize Primary and Comprehensive Stroke Centers certified by national accreditation bodies. The ASRHs meet ten criteria corresponding to the 2013 Brain Attack Coalition recommendations.Analysis: Stroke patient data are reported to the Minnesota Stroke Registry by hospital-based abstractors. Data are combined for 2012-2013, 2014-2015, and 2016-2017. Performance metric statistics were calculated using SAS (Cary, NC). The resident population living within 30 minutes of designated hospitals was calculated from 2010 US Census Bureau data using ArcGIS 10.3 Network Analyst.Results: From 2012 to 2017, the number of designated ASRHs increased from zero to 89, out of 111 eligible hospitals. The percentage of residents living within 30 minutes of any designated facility increased from 60% to 90%. The percentage of all stroke patients whose computed tomography image was initiated within 25 minutes of arrival increased from 34.2% to 42.9%. Intravenous thrombolytic therapy increased from 8.8% to 11% of all ischemic stroke patients. Median door-to-imaging time decreased from 40 to 33 minutes. Median door-to-needle time decreased from 56 to 53 minutes. 28.7% of patients in 2012-2013 who received IV tPA were treated within 4.5 hours of time last known well, increasing to 35.6% in 2016-2017.Conclusions: The Minnesota Stroke System has successfully catalyzed and supported significant improvements in acute stroke treatment in Minnesota.