To summarize and analyze the organizational structure, operational mechanisms, innovative strategies, and implementation effectiveness of the stroke tiered diagnosis and treatment model in Hubei Province, so as to provide replicable reference experience for the construction of the national stroke prevention and control system. Methods: Based on the policy framework of the“323”Offensive Action, this study systematically analyzed the construction of stroke centers and primary prevention and treatment stations, key treatment time indicators, and the implementation effects of tiered diagnosis and treatment in Hubei Province. This was achieved through policy analysis, administrative data mining, and summarization of typical practices, relying on national and provincial stroke center construction and management platforms. Results: Hubei Province has established a three-level quality control system (“Provincial Stroke Prevention and Control Center - Municipal Center - Medical Institution”) and a five-level linkage organizational architecture covering province, city, county, township, and village. As of the end of 2024, 183 stroke centers (22 tertiary and 161 secondary) and 1,029 primary stroke prevention and treatment stations had been established. The stroke emergency map covers 189 units, achieving full coverage of acute stroke treatment resources at the county level. The compliance rate for door-to-needle time (DNT) ≤ 60 min across the province reached 86.95%, and onset-to-needle time (ONT) was shortened by 40 min. Primary institutions have performed a cumulative total of 5,307 intravenous thrombolysis cases. From 2021 to 2024, the number of intravenous thrombolysis cases in tertiary hospitals increased by 117.3% , and arterial thrombectomy cases increased by 255.1%; in secondary hospitals, intravenous thrombolysis increased by 211.5%, and arterial thrombectomy increased by 696.8% . Through the mechanism of integrating medical care and prevention, high-risk screening has been conducted for approximately 20 million residents aged over 35, 847 brain-heart health managers have been trained, and closed-loop management has been implemented for over 1 million person-times. Stroke mortality rates in some regions were lower than the national and central region averages. Conclusion: By establishing a three-level quality control and five-level linkage tiered diagnosis and treatment system, and promoting technology transfer to primary care and the integration of medical care and prevention, Hubei Province has significantly improved acute stroke treatment efficiency and primary prevention and treatment capabilities. This provides replicable regional experience for the implementation of stroke tiered diagnosis and treatment in China.