BlueChoice HealthPlan

Clinical Practice Guidelines

Clinical Practice Guidelines

As part of our commitment to provide you with the latest clinical information and educational materials, we have adopted nationally recognized clinical guidelines, access to which we make available to providers through our website. The guidelines, which we use for our quality programs, are based on reasonable medical evidence and are reviewed for content accuracy, current primary sources, the newest technological advances and most recent medical research. With permission from these organizations, we have created direct links from our website to these guidelines.

While we review the guidelines annually, you should not construe these as a legal or required standard of care, or as an indication that these will always apply in every medical situation. These are recommendations only, and do not guarantee any medical results or indicate coverage for such services by any given plan or policy.

Benefit plans differ and we may not provide coverage for all services discussed in the Clinical Practice Guidelines. If you are uncertain regarding coverage of a particular service, please contact our Customer Care Center for more information and for a copy of the guidelines.

We hope these guidelines will be a convenient resource in helping you care for your patients.

Asthma

• National Heart, Lung, and Blood Institute
  • Guidelines for the Diagnosis and Management of Asthma (EPR 3 Summary Report 2007)

Behavioral Health

• American Academy of Child and Adolescent Psychiatry
  • Practice Parameter for the Assessment of Children and Adolescents with Attention-Deficit/Hyperactivity Disorder (J.AM.ACAD.CHILD ADOLESC.PSYCHIATRY.46:7.JULY 2007).
• American Psychiatric Association (APA)
  • APA Practice Guidelines for the Treatment of Psychiatric Disorders (Compendium 2006)
• American Academy of Pediatrics (AAP)
  • Bright Futures in Practice: Mental Health
  • Clinical Practice Guideline: Diagnosis and Evaluation of the Child with Attention-Deficit/Hyperactivity Disorder (PEDIATRICS Vol. 105 No. 5 May 2000, pp. 1158-1170)
  • Clinical Practice Guideline: Treatment of the School-Aged Child With Attention-Deficit/Hyperactivity Disorder (PEDIATRICS Vol. 108 No. 4 October 2001, pp. 1033-1044 )

Cancer (Supportive Care in Oncology)

• National Comprehensive Cancer Network (NCCN)
  • National Comprehensive Cancer Network Clinical Practice Guidelines for Oncology

Chlamydia

• Centers for Disease Control and Prevention (CDC)
  • Sexually Transmitted Diseases - Treatment Guidelines 2006 (Chlamydial Infections)

Chronic Heart Failure (CHF) (in the Adult)

• American College of Cardiology/American Heart Association
  • 2005 Guideline Update for the Diagnosis and Management of Chronic Heart Failure in the Adult (Journal of the American College of Cardiology 2005; 46:1116-43) (Adobe PDF document)

Chronic Obstructive Pulmonary Disease (COPD)

• American Thoracic Society/European Respiratory Society Task Force
  • Standards for the Diagnosis and Management of Patients with COPD Version 1.2. New York: American Thoracic Society; 2004 [updated 2005 September 8].

Coronary Artery Disease (CAD)

• American College of Cardiology/American Heart Association
  • 2005 Guideline Update for the Diagnosis and Management of Chronic Heart Failure in the Adult (Journal of the American College of Cardiology 2005; 46:1116-43) (inclusive of Coronary Artery Disease) (Adobe PDF document)
  • 2002 Guideline Update for the Management of Patients with Chronic Stable Angina (Journal of the American College of Cardiology 2003; 41:159-68)
• American Heart Association (AHA)
  • Evidence-Based Guidelines for Cardiovascular Disease Prevention in Women: 2007 Update (Adobe PDF document)
• American Heart Association/American College of Cardiology
  • Guidelines for Secondary Prevention for Patients with Coronary and Other Atherosclerotic Vascular Disease: 2006 Update (Journal of the American College of Cardiology 2006; 47:2130-2139)

Diabetes

• American Diabetes Association (ADA) - 2010 Clinical Practice Recommendations
  • Diabetes Care January 2010, Issue 33, Supplement 1

High Blood Cholesterol

• National Institutes of Health (NIH)
  • Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III)

Human Papillomavirus (HPV)

• Centers for Disease Control and Prevention (CDC)
  • Human Papillomavirus (HPV) Infection Treatment Guidelines 2006
  • HPV Information for Clinicians - Brochure on transmission, prevention, detection and clinical management of HPV (April 2007)

Hypertension (High Blood Pressure)

• National Heart, Lung, and Blood Institute
  • High Blood Pressure Guidelines (JNC 7)

Kidney Disease

• National Kidney Foundation: Kidney Disease Outcomes Quality Initiative 
  • KDQOI Clinical Practice Guidelines for Chronic Kidney Disease: Evaluation, Classification, and Stratification 
• Kidney Disease - KDIGO - Diagnosis, Evaluation, Prevention, and Treatment of Chronic Kidney Disease - Mineral and Bone Disorder and Care of the Kidney Disease Recipients 
  • Kidney Disease - Improving Global Outcomes 

Obesity and Overweight: Adults

• National Institutes of Health: National Heart, Lung, and Blood Institute
  • Clinical Guidelines on the Identification, Evaluation, and Treatment of Overweight and Obesity in Adults (Adobe PDF document)

Obesity and Overweight: Children

• American Academy of Pediatrics (AAP)
  • AAP Publications Retired or Reaffirmed, October 2006 (PEDIATRICS Vol. 119 No. 2 February 2007, pp. 405)
  • Active Healthy Living: Prevention of Childhood Obesity Through Increased Physical Activity (AAP Policy Statement. Pediatrics, Vol. 117 No. 5 May 2006, pp. 1834-1842) reaffirmed Feb 1, 2010
  • Dietary Recommendations for Children and Adolescents: A Guide for Practitioners (AAP Policy Statement. Pediatrics, Vol. 117 No. 2 February 2006, pp. 544-559)
  • Obesity Evaluation and Treatment: Expert Committee Recommendations (PEDIATRICS, 1998; 102, Adobe PDF document)
  • Prevention of Pediatric Overweight and Obesity (AAP Policy Statement. PEDIATRICS, Vol. 112 No. 2 August 2003, pp. 424-430.) A Statement of Reaffirmation for this policy was published on February 1, 2007.

Tobacco Use

• American Academy of Pediatrics (AAP)
  • Tobacco, Alcohol, and Other Drugs: The Role of the Pediatrician in Prevention and Management of Substance Abuse (AAP Policy Statement. PEDIATRICS Vol. 101 No. 1 January 1998, pp. 125-128) revised March 1, 2005
• National Guideline Clearinghouse
  • Counseling to Prevent Tobacco Use and Tobacco-Caused Disease: Recommendation Statement
• Washington State Department of Health
  • Smoking Cessation During Pregnancy: Guidelines for Intervention; Revised Edition 2009