Evaluating the impact of clinical practice guidelines on stroke outcomes

Abstract

A clinical practice guideline for acute ischemic stroke has been implemented in four Italian centres. Its impact in terms of applicability and effectiveness has been analysed. The evaluation methodology is based on the correlation between the compliance to the guideline and the health and economic outcomes during a six months follow-up. The paper illustrates the fundamental role that formal guideline representation, patient data model, and health care organisation model play in the evaluation task. Results show, on the clinical side, that compliance improves stroke outcomes (relative risk due to number of non-compliance 1.07, p<0.03); on the careflow process side, they highlight organisational problems, such as lack of efficient co-operation and communication. Tasks requiring external consultants are often ruled out (e.g. physiatrist visit in 61% of cases) and tasks required to be done quickly are often delayed (e.g. preliminary patient assessment in 52% of cases).