on May 31, 2007
Published online before print May 31, 2007, doi: 10.1161/STROKEAHA.106.481457
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Submitted on December 27, 2006
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. * To whom correspondence should be addressed. 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.
Accepted on January 6, 2007
Beyond Conventional Stroke Guidelines. Setting Priorities
Bo Norrving MD;
Key words: cost analysis • health priorities • needs assessment • practice guidelines • stroke services
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Stroke 2007 38: 2037.
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