Key PointsQuestionIs optimizing acute stroke emergency department care coupled with a community stroke preparedness intervention associated with increased thrombolysis treatment rates in a predominantly Black community?FindingsIn this nonrandomized controlled trial of the Stroke Ready intervention, which involved 5970 adults, optimizing emergency department care was associated with an increase in stroke thrombolysis treatment rates over time in the community.MeaningThese findings suggest that implementation science strategies in low-resource hospitals may be a good way to increase stroke thrombolysis treatments and promote health equity.