Objective To explore the effects of personal follow-up guidance based on case management on functional outcome and treatment compliance of elderly stroke patients, and lay the foundation of stroke case management ( CM ) work. Methods Totally 169 elderly stroke patients were randomly divided into the the experimental group(n=83)and the control group (n=86). Patients in the control group were given routine follow-up guidance, while patients in the experimental group were given the personal follow-up guidance based on case management. The activities of daily living and functional outcome of patients in two groups were evaluated by modified Barthel index ( MBI) and modified Rankin scale( MRS) at the time of joining the group, 1 month, 3 months, and 6 months after discharge. The compliance was evaluated by self-designed compliance questionnaire.Results There was no significant difference in MBI and MRS score between the experimental and the control group when joining the study and 1 month after discharge ( P>0. 05 ) . The MBI score of the experimental group was significantly higher and the MRS score of the experimental group was significantly lower than that in the control group at 3 months and 6 months after discharge (P<0.05). There was no significant difference in compliance score between two groups at 1 month after discharge(P>0.05), and was significantly different besides balanced diet at 3 months after discharge (P<0.05). There was no significant difference in rehospitalization rate between the experimental and the control group at 6 months after discharge (P>0.05). Conclusions The personal follow-up guidance based on the case management model can improve the activities, functional outcome and compliance of elderly stroke patients.