Evidence-based medicine, critical pathways, practice guidelines, and managed care. Reflections on the prevention and care of stroke

Abstract

Because managed care plans are exerting enormous pressure to reduce the cost of medical care, neurologists need to enhance their skills at identifying appropriate, high-quality, and cost-effective care for patients with neurological disorders. A variety of health services research methods are available that foster evidence-based decisions and de-emphasize intuition in decision making. Despite imperfect data and a lack of familiarity with some of these methods, we have found them useful in developing guidelines and pathways for the prevention and management of stroke. Neurologists should become more familiar with the pragmatic benefits, limitations, and obstacles that hinder acceptance and implementation of these approaches. If we wish to continue to influence the medical decision process, we must focus on the provision of quality neurological care and not on the managed care plan.