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Author: Kathleen Kilroy Bradford, MD, November 4, 2016

The United States is in the process of transition to value-based care and reimbursement while optimizing outcomes by delivery of quality health care based on evidence. Practice variations currently exists and there is extreme scrutiny of practice. “Large unexplained variations in care, or instances of inappropriate or inadequate care, and lack of cost-effectiveness in delivery of health care have all placed an undue burden on the system. (Shaneyfelt et al, JAMA, 281 1999, pp. 1900-1005) M. Shaneyfelt, M.F. Mayo-Smith, J. Rothwangl). “A concerted effort is underway across the spectrum of medicine to overcome these limitations and streamline the process to ensure all physicians practice with an adherence to the highest standards based on the published literature.” (Vikram P., Neurosurgical Clinics of North America, Volume 91, July 2016, pp. 611-613).

Guidelines, Clinical Pathways and Best Care recommendations.

Guidelines are systematically developed, disease-specific recommendations based on best evidence. Guidelines are designed to improve quality and consistency of care and patient outcomes by simplifying complex medical decision-making and streamlining current evidence. Guideline development involves the systematic review of evidence and an assessment of the benefits and harms of alternative care options.

Congress of Neurological Surgeons Guidelines

Clinical Practice Guidelines for Stroke– UNC Department of Neurology

Neurocritical Care Society Guidelines

Clinical Pathways are models and methods for the stepwise, criteria-based progression or  time-based, patient-care management of a well-defined group of patients. The aim of the pathway is to improve quality of care, reduce risks, increase patient satisfaction and increase efficiency of the use of resources. Clinical pathways, are also known as care pathways, critical pathways, and integrated care pathways. Pathways are also designed to reduce practice variation and improve care quality and patient outcomes.

Best Practice/Care Recommendations provide evidence- and/or consensus-based institutional recommendations for a focused clinical treatment or intervention.

Successful implementation of guidelines, pathways or best care recommendations is challenging and requires deliberate planning, multiple strategies and careful execution. Plans for education and training, communication, monitoring and improvement to facilitate the uptake of recommendations should be defined. Tools to embed them into clinical practice include order sets, algorithms, and discharge instructions. Once implemented, guidelines, pathways and best care recommendations should be reviewed and revised annually and whenever new evidence emerges or significant change is needed (Dr. Christine M. Walsh Kelly).