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Stroke Care Pathways in the U.S. and U.K.

Henry Feldman, M.D., Instructor of Medicine, Harvard Medical School/Beth Israel Deaconess Medical Center; Chief Information Architect, Division of Clinical Informatics, Department of Medicine, Harvard Medical School /Beth Israel Deaconess Medical Center

Stan N. Finkelstein, M.D., Senior Research Scientist, MIT Engineering Systems Division and Harvard-MIT Division of Health Sciences and Technology; Professor, Clinical Computing Division, Department of Medicine, Beth Israel Deaconess Medical Center; Senior Lecturer, Department of Health Care Policy, Harvard Medical School

Consensus among experts is that the effective management of patients with stroke is enhanced by systematic support of the components of care. A leading cause of morbidity and mortality in virtually all industrialized countries, stroke has been the object of comprehensive guidelines released by major professional societies. These guidelines incorporate some of the latest innovations in therapy and technology to diagnose the condition and intervene in its clinical course. But these guidelines only prove useful when translated to locally meaningful pathways of care delivery. We contrast the degree of adherence to these clinical guidelines in the United States and the United Kingdom. Initial comparisons are at the level of two acute care general hospitals, one in each country. A broader comparison is also attempted using data available from national or regional surveys of stroke care. Differences in pre-hospital acute care and post-hospital management across the two countries are examined in relation to the nature and quantity of resources available to provide various aspects of stroke management, the systems of health care financing, and the cultures that guide medical practice.

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