THE STROKE PREVENTION POLICY MODEL - LINKING EVIDENCE AND CLINICAL DECISIONS

Simulation models that support decision and cost-effectiveness analysi s can further the goals of evidence-based medicine by facilitating the synthesis of information from several sources into a single comprehen sive structure. The Stroke Prevention Policy Model (SPPM) performs thi s function for the clinical and policy questions that surround stroke prevention. This paper first describes the basic structure and functio ns of the SPPM, concentrating on the role of large databases (broadly defined as any database that contains many patients, regardless of stu dy design) in providing the SPPM inputs. Next, recognizing that the us e of modeling continues to be a source of some controversy in the medi cal community, it; discusses the philosophical underpinnings of the SP PM. Finally, it discusses conclusions in the context of both stroke pr evention and other complex medical decisions. We conclude that despite the difficulties in developing comprehensive models (for example, the length and complexity of model development and validation processes, the proprietary nature of data sources, and the necessity for developi ng new software), the benefits of such models exceed the costs of cont inuing to rely on more conventional methods. Although they should not replace the clinician in decision making; comprehensive models based o n the best available evidence from large databases can support decisio n making in medicine.