BlueChoice HealthPlan

Clinical Practice Guidelines

Clinical Practice Guidelines

The practice guidelines included on this website are not intended to be required treatment protocols. Physicians and other health professionals must rely on their own expertise in evaluating and treating patients. Practice guidelines are not a substitute for the best professional judgment of physicians and other health professionals. Behavioral health guidelines may include commentary developed by our behavioral health committees.

Further, while we consult authoritative sources in the development of these guidelines, the practice guideline may differ in some respects from the sources cited. With respect to the issue of coverage, each patient should review his or her Policy or Certificate and Schedule of Benefits for details concerning benefits, procedures and exclusions before receiving treatment. The practice guidelines do not supersede the Policy or Certificate and Schedule of Benefits.

Asthma (reviewed 5/11)

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

 

Cancer (reviewed 11/11)

• Provider and member resources are available through: 
  
  • The American Cancer Society
  • National Comprehensive Cancer Network (Free registration required to access NCCN content)

Chlamydia (reviewed 2/11)

• Centers for Disease Control and Prevention (CDC)
  • Sexually Transmitted Diseases - Treatment Guidelines 2010 (Chlamydial Infections)

Chronic Heart Failure (CHF) (in the Adult) (reviewed 5/11)

• American Heart Association/American College of Cardiology
  • 2009 Focused Update Incorporated Into the ACC/AHA 2005 Guidelines for the Diagnosis and Management of Heart Failure in Adults. A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines (Circulation, April 14, 2009) 

Chronic Obstructive Pulmonary Disease (COPD) (reviewed 5/11)

• Global Initiative for Chronic Obstructive Pulmonary Disease 
  • Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Pulmonary Disease (Bethesda [MD]: GOLD; 2010 97 p. [462 references])

Coronary Artery Disease (reviewed 5/11)

• American Heart Association/American College of Cardiology
  • AHA/ACC Guidelines for Secondary Prevention for Patients with Coronary and Other Atherosclerotic Vascular Disease: 2006 Update (Endorsed by the NHLBI. Circulation. May 2006; 113:2363-2372.)
• American Heart Association (AHA)
  • Treatment of Hypertension in the Prevention and Management of Ischemic Heart Disease: A Scientific Statement from the American Heart Association for High Blood Pressure Research and the Councils on Clinical Cardiology and Epidemiology and Prevention (Circulation 2007;115;2761-2788.)
  • Effectiveness-Based Guidelines for the Prevention of Cardiovascular Disease in Women: 2011 Update: A Guideline from the American Heart Association (Circulation 2011; 123; 1243-1262; originally published online February 14, 2011.)

Diabetes (reviewed 2/11)

• American Diabetes Association (ADA) - 2011 Standards of Medical Care in Diabetes
  • American Diabetes Association - Clinical Practice Recommendations 2011

High Blood Cholesterol (reviewed 9/11)

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

Human Papillomavirus (HPV) (reviewed 2/11)

• Centers for Disease Control and Prevention (CDC)
  • Sexually Transmitted Diseases - Treatment Guidelines 2010 (Human Papillomavirus Infections)

Hypertension (High Blood Pressure) (reviewed 9/11)

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

Kidney Disease (reviewed 5/11)

• Kidney Foundation: Kidney Disease Outcomes Quality Initiative 
  • KDQOI Clinical Practice Guidelines for Chronic Kidney Disease: Evaluation, Classification, and Stratification 

Maternity and Perinatal (reviewed 2/11)

• Perinatal Care Guidelines Summary (Based on the Guidelines for Perinatal Care, Sixth Edition, 2007, the American Academy of Pediatrics [AAP] and the American College of Obstetricians and Gynecologists [ACOG].)
  • Summary of Perinatal Care Guidelines
• If you wish to order the complete copy of the Guidelines for Perinatal Care, Sixth Edition, please click on the link below. It will take you directly to the ACOG site to order your own copy.
  • Guidelines for Perinatal Care, Sixth Edition (2007)

Metabolic Syndrome (reviewed 9/11)

• American Heart Association
  • AHA Diagnosis and Management of the Metabolic Syndrome: An American Heart Association/National Heart, Lung, and Blood Institute Scientific Statement Executive Summary, Oct 2005; Circulation 2005; 112;285-290.

Musculoskeletal – Low Back Pain (reviewed 9/11)

• American College of Physicians/American Pain Society
  • Diagnosis and Treatment of Low Back Pain: A Joint Clinical Practice Guideline from the American College of Physicians and the American Pain Society Ann Intern Med October 2, 2007 vol. 147 no.7 478-491.
  • Summary of Interventional Therapies, Surgery and Interdisciplinary Rehabilitation for LBP from the Interventional Therapies, Surgery, and Interdisciplinary Rehabilitation for Low Back Pain: An Evidence-Based Clinical Practice Guideline From the American Pain Society. Spine 2009; 34:1066-1077. If you wish to order the complete copy of this report, please visit the Spine website to order.

Musculoskeletal – Osteoarthritis of the Hip and Knee (reviewed 9/11)

• American College of Rheumatology
  • Recommendations for the Medical Management of Ostheoarthritis of the Hip and Knee American College of Rheumatology Subcommittees on Osteoarthritis Guidelines. Arthritis & Rheumatism 2000 Sept. 43(9): 1905-15.
• American Academy of Orthopaedic Surgeons
  • Guideline on the Treatment of Osteoarthritis (OA) of the Knee Adopted by the American Academy of Orthopaedic Surgeons, Board of Directors, December 6, 2008.

Musculoskeletal – Osteoporosis (reviewed 9/11)

• National Osteoporosis Foundation
  • Clinician's Guide to Prevention and Treatment of Osteoporosis. Washington DC. 2010.

Musculoskeletal - Rheumatoid Arthritis (reviewed 9/11)

• American College of Rheumatology
  
  • 2008 Recommendations for the Use of Nonbiologic and Biologic Disease-Modifying Antirheumatic Drugs in Rheumatoid Arthritis Arthritis and Rheumatism. 2008 June: 59(6):762-784.

 

Obesity and Overweight: Adults (reviewed 2/11)

• National Obesity Education Initiative of the National Heart, Lung, and Blood Institute (NHLBI), 1998
  • Clinical Guidelines on the Identification, Evaluation, and Treatment of Overweight and Obesity in Adults

Obesity and Overweight: Children (reviewed 2/11)

• Expert Committee Recommendations Regarding the Prevention, Assessment, and Treatment of Child and Adolescent Overweight and Obesity
  • Summary Report (Pediatrics. Vol. 120 Supplement December 2007, pp. S164-S192)
• U.S. Preventive Services Task Force
  • Screening for Obesity in Children and Adolescents (Pediatrics Feb 2010; 125 (2): 361-7)

Tobacco Use (reviewed 12/11)

• 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)
• U.S. Preventive Services Task Force 
  • Counseling and Interventions to Prevent Tobacco Use and Tobacco-Caused Disease in Adults and Pregnant Women