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Alcohol/Substance Abuse & Dependency - Evaluation and Management 2nd Edition, 2009 Update
Apollo Managed Care Consultants, June 2009, Pages: 95
Each guideline must be reviewed by the medical policy committee of the HMO or contracted/delegated medical group or other providers 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 improve the document by the added input.
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 annually, or in some cases 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.
Use clear and unambiguous language in a stated policy or procedure. Avoid any implications of guaranteed clinical results or outcomes as a result of following a particular guideline. All policies, procedures, guidelines and similar criteria should be followed consistently and be in writing.
If the distribution of the guideline is not followed by feedback and reinforcement, compliance will be minimal.
When using this manual, it should be noted that the policies/guidelines are all 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 or Medicare and/or other objective sources of new information.
Guidelines are a roadmap with options for the route to be traveled, not a standard of care.
To assure an organized process for the compilation, approval and distribution of medical policy and related information, all policies or guidelines proposed for use by any physician or medical organization should be submitted to the Medical Director or Vice President, Medical Services for detailed review, circulation to others in the organization and specific approval prior to implementation.
Product samples
Alcohol-Substance Abuse and Dependency 2009 - Sample
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