INTRODUCTION: Despite the availability of prevention and therapies of stroke, their implementation in clinical practice, even of low-cost ones, remains poor. In 2015, the European Stroke Organisation (ESO) initiated the ESO Enhancing and Accelerating Stroke Treatment (EAST) program, which aims to improve stroke care quality, primarily in Eastern Europe. Here, we describe its methods and milestones. PATIENTS AND METHODS: The ESO EAST program is using an implementation strategy based on a 'detecting-understanding-reducing disparities' conceptual framework: stroke care quality is first measured (after developing a platform for data collection), gaps are identified in the current service delivery, and ultimately feedback is provided to participating hospitals, followed by the application of interventions to reduce disparities. The ESO EAST program is carried out by establishing a stroke quality registry, stroke management infrastructure, and creating education and training opportunities for healthcare professionals. RESULTS: Program management and leadership infrastructure has been established in 19 countries (Country Representatives in 22 countries, National Steering Committee in 19 countries). A software platform for data collection and analysis: Registry of Stroke Care Quality was developed, and launched in 2016, and has been used to collect data from over 90,000 patients from >750 hospitals and 56 countries between September 2016 and May 2019. Training in thrombolysis, nursing and research skills has been initiated. DISCUSSION: ESO EAST is the first pan-Eastern European (and beyond) multifaceted quality improvement intervention putting evidence-informed policies into practice. Continuous monitoring of stroke care quality allows hospital-to-hospital and country-to-country benchmarking and identification of the gaps and needs in health care.

2nd Department of Neurology Institute of Psychiatry and Neurology Warsaw Poland

Comprehensive Stroke Unit MC 'Universal Clinic 'Oberig' Kyiv Ukraine

Department of Acute Cerebrovascular Pathology and Emergency Neurology Research Institute of Emergency Medicine n a 1 I Dzhanelidze Saint Petersburg Russia

Department of Clinical Neurology Psychiatry and Narcology 5 N Karazin Kharkiv National University Kharkiv Ukraine

Department of Clinical Neurosciences University of Medicine and Pharmacy Carol Davila Bucharest Romania

Department of Neurology and Neurosurgery Institute of Clinical Medicine Faculty of Medicine University of Tartu Tartu Estonia

Department of Neurology and Neurosurgery National Center of Epileptology Institute of Emergency Medicine Chisinau Moldova

Department of Neurology Med Campus 3 Kepler University Hospital Linz Austria

Department of Neurology Semmelweis University Budapest Hungary

Department of Neurology Stroke and Intensive Care Unit Sveti Duh University Hospital Zagreb Croatia

Faculty of Medicine Department of Neurology P J Šafárik University University Hospital L Pasteur Košice Slovakia

International Clinical Research Center and Department of Neurology St Anne's University Hospital and Medical Faculty of Masaryk University Brno Czech Republic

International Clinical Research Center St Anne's University Hospital Brno Czech Republic

Laboratory of Neurobiology and Medical Genetics State University of Medicine and Pharmacy Nicolae Testemiţanu Chisinau Moldova

Medical University Varna University Hospital St Marina 2nd Clinic of Neurology with ICU and Stroke Unit Varna Bulgaria

Neurology Clinic Medical University of Sofia Sofia Bulgaria

Santa Maria della Misericordia Hospital University of Perugia Perugia Italy

Shaare Zedek Medical center Jerusalem Tel Aviv University Tel Aviv Israel

Stroke Unit Department of Neuroscience San Camillo Forlanini Hospital Rome Italy

University Clinic of Neurology Medical Faculty University Ss Cyril and Methodius Skopje North Macedonia

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