Beyond conventional stroke guidelines: setting priorities.
OBJECTIVE
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.
Norrving
Bo
B
Department of Neurology, University Hospital, Lund, Sweden.
Wester
Per
P
Sunnerhagen
Katharina Stibrant
KS
Terént
Andreas
A
Sohlberg
Anna
A
Berggren
Fredrik
F
Wester
Per-Olov
PO
Asplund
Kjell
K
D003362:Cost-Benefit Analysis; D017408:Guidelines as Topic; D017048:Health Care Costs; D015276:Health Care Rationing; D006292:Health Priorities; D006295:Health Resources; D006301:Health Services Needs and Demand; D006801:Humans; D020521:Stroke / Q000175:diagnosis / Q000191:economics / Q000628:therapy; D013548:Sweden