***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Background and Purpose — Integrated care pathways ( ICP ) may not reduce disability , institutionalization , or duration of hospitalization compared with conventional multidisciplinary team ( MDT ) care in organized stroke rehabilitation . Their potential to improve patient heath status or satisfaction with care is not known . Methods — A comparison of quality of life , caregiver strain , and patient/caregiver satisfaction at 6 months after stroke was undertaken in 152 stroke patients r and omized to receive ICP or MDT care .  Differences in processes of care were recorded with the use of a predefined schedule . Multivariate analyses were undertaken to identify the effect of age , sex , stroke severity , functional status , mood , and use of care pathway on quality of life score . Results — The 2 groups were comparable for baseline characteristics of age , sex , stroke severity , and initial disability . MDT care was characterized by greater emphasis on return of higher function and caregiver needs compared with ICP . EuroQol Visual Analogue Scale ( EQ-VAS ) scores were higher in the MDT group ( median , 72 versus 63;P < 0.005 ) , who also had higher scores for EuroQol dimension of social functioning ( P = 0.014 ) . Higher EQ-VAS scores were independently related to MDT care ( P = 0.04 ) , Rankin score ( P = 0.01 ) , and psychological function ( P < 0.0001 ) but not to age , sex , or stroke severity . There were no significant differences in patient or caregiver satisfaction between the 2 setting s. Conclusions — Better quality of life in patients receiving conventional MDT care may be attributable to improved social functioning and greater attention to higher function and caregiver needs during rehabilitation This paper describes the results of a study of elderly patients admitted to hospital with fractured neck of femur , cerebral vascular accident or amputation of a lower limb who were , immediately post-crisis , transferred to a unit where nursing was perceived as the chief therapeutic activity . Patients ' outcomes were compared with a control group who followed a normal patient pathway , either remaining in an acute hospital ward until discharge or being transferred to a community hospital for part of their stay . The study was a modified replication of a small pilot study carried out between 1983 and 1985 To compare the use of  r and omized controls ( RCTs ) and historical controls ( HCTs )  for clinical trials , we search ed the literature for therapies studied by both methods . We found six therapies for which 50 RCTs and 56 HCTs were reported . Forty-four of 56 HCTs  ( 79 percent ) found the therapy better than the control regimen , but only 10 of 50 RCTs ( 20 percent ) agreed . For each therapy , the treated patients in RCTs and HCTs of the same therapy was largely due to differences in outcome for the control groups , with HCT control patients generally doing worse than the RCT control groups . Adjustment of the outcomes of the HCTs for prognostic factors , when possible , did not appreciably change the results . The data suggest that biases in patient selection may irretrievably weight the outcome of HCts in favor of new therapies . RCTs may miss clinical ly important benefits because of inadequate attention to sample size . The predictive value of each might be improved by reconsidering the use of p less than 0.05 as the significance level for all types of clinical trials , and by the use of confidence intervals around estimates of treatment effects A r and omized controlled trial was conducted to examine the effects of interdisciplinary team care on acute hospitalized stroke patients . After obtaining baseline information on 42 stroke victims receiving conventional care in a general hospital , 130 stroke patients were stratified and r and omly assigned either to Traditional or Team care . Assessment s by independent evaluators permitted comparisons between Team and Traditional groups with reference to patient survival , motor performance and functional abili- ties . Data obtained prospect ively from charts and treatment logs allowed the care process across groups to be compared . Results demonstrated that Team and Traditional patients fared similarly in survival . How- ever there was an unexpected difference in survival depending upon sex . For motor performance , male survivors performed better with Team care and female survivors with the Traditional method . In terms of functional abilities , male patients receiving Team care again performed better than their Traditional counterparts , whereas in women there was no difference between the treatment groups . Stroke Vol 15 , No 5 , OBJECTIVE to evaluate whether integrated care pathways improve the processes of care in stroke rehabilitation . DESIGN comparison of processes of care data collected in a r and omized controlled trial . PARTICIPANTS acute stroke patients undergoing rehabilitation r and omized to receive integrated care pathways management ( n=76 ) or conventional multidisciplinary care ( n=76 ) . MEASUREMENTS proportion of patients meeting recommended st and ards for processes of care using a vali date d stroke audit tool . RESULTS integrated care pathways methodology was associated with higher frequency of stroke specific assessment s , notably testing for inattention ( 84 % versus 60 % ; P=0.015 ) and nutritional assessment ( 74 % versus 22 % , P<0.001 ) . Documentation of provision of certain information to patients /carers ( 89 % versus 70 % ; P=0.024 ) and early discharge notification to general practitioners ( 80 % versus 45 % ; P<0.001 ) were also more common in this group . There were no significant differences in the processes of interdisciplinary co-ordination and patient management between the integrated care pathways group and the control group . CONCLUSION integrated care pathways may improve assessment and communication , even in specialist stroke setting BACKGROUND AND PURPOSE Integrated Care Pathway ( ICP ) is an organized , goal -defined , and time-managed plan that has the potential of facilitating timely interdisciplinary coordination , improving discharge planning , and reducing length of hospital stay . METHODS An ICP for stroke rehabilitation based on evidence of best practice , professional st and ards , and existing infrastructure was developed . Its effectiveness was tested in 152 stroke patients undergoing rehabilitation who were r and omized to receive ICP care coordinated by an experienced nurse ( n=76 ) or conventional multidisciplinary care ( n=76 ) . RESULTS The age , sex , premorbid functional ability , and stroke characteristics of the 2 groups were comparable . There were no differences in mortality rates ( 10 [ 13 % ] versus 6 [ 8 % ] ) , institutionalization ( 10 [ 13 % ] versus 16 [ 21 % ] ) , or length of hospital stay ( 50+/-19 versus 45+/-23 days ) between patients receiving ICP or multidisciplinary care . Patients receiving conventional multidisciplinary care improved significantly faster between 4 and 12 weeks ( median change in Barthel Activities of Daily Living Index 6 versus 2 ; P<0.01 ) and had higher Quality of Life scores at 12 weeks ( 65 versus 59 ; P=0.07 ) and 6 months ( 72 versus 63 ; P<0.005 ) . There were no significant differences in the mean duration of physiotherapy ( 42.8+/-41.2 versus 39.4+/-36.4 hours ) or occupational therapy ( 8.5+/-7.5 versus 8.0+/-7.5 hours ) received between the 2 groups . CONCLUSIONS ICP management offered no benefit over conventional multidisciplinary care on a stroke rehabilitation unit . Functional recovery was faster and Quality of Life outcomes better in patients receiving conventional multidisciplinary care Background and Purpose — Better processes in stroke care are assumed to lead to better stroke outcomes . We sought to test whether current measures of stroke process are related to measures of stroke outcome . Methods — This was a prospect i ve study of consecutive patients with acute stroke admitted to each of the 3 general hospitals in 1 region who were followed up for 12 months after hospital discharge .  Process was measured by use of the Royal College of Physicians Stroke Audit Package , and outcomes were measured with a range of disability , health status , h and icap , and independence measures , as well as mortality . Results — One hundred eighty-one patients were recruited . There was evidence for a relationship between some process variables and outcomes at hospital discharge , but the relationships were generally weak . None of the process variables remained in regression models of functional outcomes at 12 months . The hospital with the best process scores had the worst case mix-adjusted outcomes . Conclusions — The link between stroke process and outcome , through the use of currently available measures of process such as the Royal College of Physicians Stroke Audit Package , is not straightforward . Ongoing work may clarify some of these issues and provide guidance to stroke clinicians on how best to improve existing services In recent years , intense pressures to reduce the costs of health care have led many health care organizations to seek strategies that reduce re source utilization while maintaining the quality of care [ 1 - 5 ] . Among the most popular of the methods intended to meet this challenge are critical pathways . Critical pathways are management plans that display goals for patients and provide the corresponding ideal sequence and timing of staff actions to achieve those goals with optimal efficiency [ 6 - 8 ] . Interest in critical pathways has increased tremendously during the past several years as early anecdotal reports of their cost-saving potential have been disseminated , usually outside the peer- review ed medical literature [ 7 , 9 , 10 ] . The rapid push for critical pathway implementation comes from intense competitive pressures and the persistent evidence of unexplained variation in medical practice [ 11 , 12 ] . Many managed care organizations have added their weight to this process by m and ating certain critical pathways or seeking partner hospitals that are willing to develop their own [ 7 ] . However , no controlled study has shown a critical pathway to reduce the duration of hospital stay or to decrease re source use , nor has any study shown critical pathways to improve patient satisfaction or outcomes [ 13 ] . Nevertheless , like other promising medical technologies , critical pathways are being disseminated before controlled trials have been done to evaluate their effectiveness . Despite the lack of data , an increasing number of physicians will be asked to participate in critical pathway development . Even more will find that their hospitalized patients are already on pathways that they may or may not have endorsed . To enhance the effectiveness of critical pathways and minimize the disruption to the patientphysician relationshipphysicians and other caregivers must underst and the origin , potential benefits , and potential pitfalls of this new method . Critical Pathways : A New Form of Clinical Guideline Critical pathways have varying formats and are known by many names , including critical paths , clinical pathways , and care paths . Interpreted formally , a critical pathway is the sequence of events in a process that takes the greatest length of time . Like the techniques of continuous quality improvement , critical pathway techniques were first developed for use in industry as a tool to identify and manage the rate-limiting steps in production processes [ 14 - 17 ] . First developed in the 1950s , the Critical Path Method was frequently linked with a similar approach , the Program Evaluation and Review Technique , to coordinate multiple contractors or persons in a project by identifying the key sequence of events , or critical path , the requirements of which would drive the timeline of the overall project [ 18 , 19 ] . Critical pathway techniques have subsequently been applied to projects as diverse as construction , civil engineering , town planning , marketing , ship building , product design , and equipment installation [ 6 ] . Critical pathways were first developed and applied to health care in the 1980s , when prospect i ve payment systems focused greater interest on potential methods to improve hospital efficiency [ 6 ] . Most of the first critical pathways in hospitals were developed by nurses for nursing care alone [ 20 , 21 ] , but multidisciplinary teams soon began developing pathways to encompass all aspects of care for hospitalized patients [ 22 - 24 ] . In general , efforts to develop critical pathways in health care have not incorporated the formal techniques used by industrial predecessors to identify the true critical pathway in any care process [ 18 , 25 ] . Instead , when critical pathways are used to plan medical care , the specific goals usually include the following : 1 . Selecting a best practice when practice styles vary unnecessarily . 2 . Defining st and ards for the expected duration of hospital stay and for the use of tests and treatments . 3 . Examining the interrelations among the different steps in the care process to find ways to coordinate or decrease the time spent in the rate-limiting steps . 4 . Giving all hospital staff a common game plan from which to view and underst and their various roles in the overall care process . 5 . Providing a framework for collecting data on the care process so that providers can learn how often and why patients do not follow an expected course during their hospitalization . 6 . Decreasing nursing and physician documentation burdens . 7 . Improving patient satisfaction with care by educating patients and their families about the plan of care and involving them more fully in its implementation . The general format of critical pathway guidelines is the Gantt chart , which outlines the suggested patient care process based on a time-task matrix , listing the components of care in one column and cross-aligning these entries with columns pertaining to time [ 8 ] . Figure 1 is an example of such a chart for a critical pathway for patients who have had coronary artery bypass graft surgery . Categories of multidisciplinary staff actions are listed in the first column of the pathway , with specific actions for each day of hospitalization . As indicated in Figure 1 , a patient 's diet is expected to progress successfully from ice chips to clear liquids on the first day after surgery . For all other categories of patient care , critical pathways likewise explicitly mark the transition points of patient progress and lay out a coordinated map of staff activities to achieve those transitions in the most efficient way possible . Figure 1 . The first 2 days of a simplified critical pathway for patients who have had cardiac surgery .  Critical pathways differ from most clinical guidelines , protocol s , and algorithms in several key respects . First , clinical guidelines often address the appropriateness of care by delineating the indications for tests or treatments . Critical pathways , on the other h and , have almost always focused on the quality and efficiency of care after decisions have already been made to admit the patient or perform the procedure . Another way in which critical pathways differ from 
    Output:
    
There was significant statistical heterogeneity in the analysis of many of the outcomes .
We found no significant difference between care pathway and control groups in terms of death or discharge destination .
REVIEW ERS ' CONCLUSIONS Use of stroke care pathways may be associated with positive and negative effects .
There is currently insufficient supporting evidence to justify the routine implementation of care pathways for acute stroke management or stroke rehabilitation