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(Stroke. 2007;38:2185.)
© 2007 American Heart Association, Inc.

Comments, Opinions, and Reviews

Beyond Conventional Stroke Guidelines

Setting Priorities

Bo Norrving, MD; Per Wester, MD; Katharina Stibrant Sunnerhagen, MD; Andreas Terént, MD; Anna Sohlberg, MpolSc; Fredrik Berggren, PhD; Per-Olov Wester, MD; Kjell Asplund, MD for the Stroke Guidelines Working Group,; National Board of Health and Welfare, Stockholm, Sweden

From the Department of Neurology (B.N.), University Hospital, Lund, Sweden; Department of Medicine (P.W.), University Hospital, Umeå, Sweden; Institute of Neuroscience and Physiology/Rehabilitation Medicine (K.S.S.), Sahlgrenska Academy at Göteborg University, Göteborg, Sweden; National Board of Health and Welfare (A.S., F.B., P.O.W., K.A.), Stockholm, Sweden.

Correspondence to Kjell Asplund, Director General, National Board of Health and Welfare, S-10630 Stockholm, Sweden. E-mail kjell.asplund{at}sos.se

Background and Purpose— Priorities in the care of stroke patients are often intuitive. An open and translucent priority-setting procedure would benefit patients, professionals, and decision-makers. Prioritization is an innovative part of the new Swedish national stroke guidelines.

Methods— Working groups identified diagnostic procedures, interventions and therapies in stroke care, assessed each one according to severity (needs), effect of action, level of scientific evidence and cost-effectiveness. The items were then ranked into priority groups from 1 (highest) to 10 (lowest). Procedures lacking evidence for routine clinical use were also identified (and entered a do-not-do list), as well as procedures in research and development. Resource allocations resulting from the priority-setting process were identified.

Results— Of 102 core procedures identified, 50 were assigned to high-priority groups (1–3), 29 to moderate priority groups (4–7) and 23 to low priority groups (8–10). Almost a quarter were graded 8 to 10, indicating that they may not necessarily be applied if resources are scarce. Twenty-eight procedures were assigned to the do-not-do list and 16 to the research and development list.

Conclusions— In stroke services, it is possible to identify not only diagnostic procedures and interventions with high priority, but also a considerable number of items used today that have low priority or should not be used at all. Strict adherence to the guidelines would result in a substantial reallocation of resources from low-priority to high-priority areas.

Key Words: cost analysis • health priorities • needs assessment • practice guidelines • stroke services

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Explicit Priority Setting in Clinical Guidelines: The Next Frontier?

Peter Langhorne
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