EVIDENCE-BASED MEDICINE, CRITICAL PATHWAYS, PRACTICE GUIDELINES, AND MANAGED CARE - REFLECTIONS ON THE PREVENTION AND CARE OF STROKE

Because managed care plans are exerting enormous pressure to reduce th e cost of medical care, neurologists need to enhance their skills at i dentifying appropriate, high-quality, and cost-effective care for pati ents with neurological disorders. A variety of health services researc h methods are available that foster evidence-based decisions and de-em phasize intuition in decision making. Despite imperfect data and a lac k of familiarity with some of these methods, we have found them useful in developing guidelines and pathways for the prevention and manageme nt of stroke. Neurologists should become more familiar with the pragma tic benefits, limitations, and obstacles that hinder acceptance and im plementation of these approaches. If we wish to continue to influence the medical decision process, we must focus on the provision of qualit y neurological care and not on the managed care plan.