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Disease State Management Strategies I Clinical Guidelines for Primary Care 3nd Edition (2009 Update)
Apollo Managed Care Consultants, March 2009, Pages: 585
These guidelines are not to be used as fixed or rigid protocols or standards of care. Treatment must be based on meeting the documented needs of each patient. Guidelines are patient management strategies, not entirely inclusive or exclusive of all methods of reasonable care that can obtain the same results, or of those which consider the particular needs of the patient and available resources. While standards imply a rigid and mandatory adherence that make exceptions unusual and difficult to justify, guidelines are flexible.
This information is provided as a general reference and is not intended to address every aspect of a clinical situation that may exist now, or in the future. Physicians and health care professionals must exercise clinical discretion in interpreting and applying this information to individual patients. Guidelines cannot account for variation among patients. They are not intended to supplant physician judgment with respect to particular patients or special clinical situations.
This information is provided to you for general reference and is not intended to address every aspect of a clinical situation that may exist now, or in the future. Physicians and health care professionals must exercise clinical discretion in interpreting and applying this information to individual patients.
All guidelines, review criteria and similar materials in this manual constitute neither offers of coverage nor medical advice. Apollo Managed Care Consultants does not provide health care services and, therefore, cannot guarantee any results or outcomes. Treating providers are solely responsible for medical advice and treatment of any individual. These guidelines, review criteria and the like may be updated periodically and therefore are subject to change without notice to the purchaser.
Each guideline must be reviewed by a medical policy (or similar) committee of representative physicians and other providers for the HMO or contracted/delegated medical group and modified and adapted as appropriate. It is strongly recommended that all applicable documents that will be used to manage medical care in the organization be sent to affected providers for review and comment prior to implementation. This will always promote an understanding of the guideline, avoid compliance issues, and frequently may improve the document by added input prior to implementation.
A trial implementation using a small number of supportive providers and staff is often useful for any new policy, procedure or guideline implementation. All proposed guidelines should be compared to others as well as the constantly evolving national standards of care.
Cost effective health care is quality driven (true quality, that is; not excessive care) and attention must always be focused on the issues that will result in optimal medical/surgical outcomes in the specific local medical environment. Guideline compliance remains a major issue. Neither CQI teams nor academic detailing have proven to be particularly effective.
Once adopted, all policies, procedures, guidelines, protocols, benefit interpretations, review criteria, pathways and the like should be reviewed at least every two years, or even more frequently, as clinically significant changes occur due to new technology, medications or practices entering the medical mainstream. The sources of the information in a guideline, whenever possible, should be included as a reference or footnote.
If the distribution of the guideline is not followed by a process that includes auditing for compliance, feedback of the results, process and other improvements where indicated, and positive reinforcement strategies, recidivism tends to occur and over time, compliance will gradually return to levels present before institution of the guideline.
Use clear and unambiguous language in a stated policy or procedure. Avoid any implications of guaranteed clinical results or promised outcomes as a result of following a particular guideline. All policies, procedures, guidelines and similar criteria should be followed consistently and be available in writing.
When using this manual, it should be noted that the policies/guidelines may be subject to contractual limitations and changes that occur periodically based on objective studies in the medical literature, recommendations by national bodies such as the AMA, ACP, ACS, Medicare and/or other objective authoritative sources of information.
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