PROJECT SUMMARY The goal of this K01 application is to provide an individualized program of mentored research training for Dr. Deanna Saylor, an Assistant Professor in the Department of Neurology at the Johns Hopkins University School of Medicine. Dr. Saylor has been based full-time in Zambia since 2018 where, in collaboration with local stakeholders, she has launched the first neurology inpatient unit and first neurology post-graduate training program in the country. Dr. Saylor is applying for an International Research Scientist Development Award to gain skills and experience in implementation science research. Combined with her background in clinical and epidemiological research, this new skillset will uniquely position her to both generate new knowledge and help develop care systems that effectively implement new knowledge to improve patient outcomes. The research plan outlined in this application leverages the developing system of neurological care in Zambia to understand current stroke care practices at the University Teaching Hospital (UTH; Zambia's national referral hospital), develop locally relevant stroke clinical practice guidelines, and examine the effect of their implementation on stroke outcomes. Since stroke is the second leading cause of adult disability and mortality worldwide and stroke prevalence in sub-Saharan Africa is amongst the highest in the world, these data are urgently needed to address this national, regional, and global health problem. The proposed research includes a pre-intervention prospective cohort of patients with stroke at UTH to characterize current stroke care clinical practices and stroke outcomes (aim 1). A stroke working group including relevant stakeholders will then be convened to investigate community, patient, provider, and health systems factors leading to difficulty achieving stroke quality measures and optimal outcomes. The Adopt-Contextualize-Adapt framework will then be used to develop locally relevant clinical practice guidelines from international stroke guidelines for implementation (aim 2). These guidelines will then be implemented, and a post-intervention observational cohort study conducted to examine their impact on achieving stroke quality measures and improving stroke outcomes. This K01 will also support Dr. Saylor's training goals which include gaining additional training and mentorship in the following key areas: (1) implementation science frameworks and methodology; (2) qualitative data methods and analysis; (3) stroke clinical research methods, especially aspects unique to global settings; and (4) developing an international network of collaborators for future large-scale and generalizability studies. In order to achieve these goals, Dr. Saylor has established an international team of mentors with expertise in implementation science, qualitative studies, stroke research, neurology research in sub-Saharan Africa, and stroke center development in international settings. This award will...