title: Applying Clinical Practice Guidelines to the Complex Patient: Insights for Practice and Policy from Stroke Rehabilitation.
abstract: In Canada, policy makers are working to align services with the Stroke Rehabilitation Best Practice Recommendations (SRBPR). Complicating the application of clinical practice guidelines (CPGs) is the fact that most strokes occur in the context of other diagnoses. We sought to understand clinicians' use of the CPGs and ascertain how much guidance regarding multimorbidity was available in the SRBPR. Study results indicated that using the recommendations was problematic due to a perceived lack of guidance regarding comorbidities and multimorbidity, and concerns regarding the applicability to "real-life patients." Comorbidities were mentioned in less than half of the recommendations, but no explicit guidance was provided regarding the management of comorbidities. Given the prevalence of multimorbidity in stroke rehabilitation, this clinical context is ideal for development and testing of CPGs that account for multimorbidity and other complexity factors. Results may also suggest limitations to using CPGs in the development of activity-based funding models.
authors.affiliation: Research scientist at the Bridgepoint Collaboratory; Lunenfeld-Tanenbaum Research Institute. Her program of research focuses on complexity in inpatient stroke rehabilitation and community reintegration. She also holds appointments at the Daphne Cockwell School of Nursing at Ryerson University and the Dalla Lana School of Public Health, University of Toronto, ON.
authors.forename: Michelle L A
authors.initials: ML
authors.lastname: Nelson
authors.affiliation: Post-doctoral fellow funded by the Health System Performance Research Network at the Bridgepoint Collaboratory for Research and Innovation of the Lunenfeld-Tanenbaum Research Institute, Institute and Institute of Health Policy, Management and Evaluation, University of Toronto, ON. Her program of research focuses on goal setting and care coordination for complex patients.
authors.forename: Agnes
authors.initials: A
authors.lastname: Grudniewicz
authors.affiliation: Medical resident in the Department of Family Medicine at Queens University, Kingston, ON, with an interest in patient complexity and the application of clinical practice guidelines.
authors.forename: Sarah
authors.initials: S
authors.lastname: Albadry
mesh_terms: D002170:Canada; D015897:Comorbidity; D017144:Focus Groups; D006801:Humans; D017410:Practice Guidelines as Topic; D020521:Stroke / Q000150:complications; D000071939:Stroke Rehabilitation / Q000379:methods* / Q000592:standards*