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Clinical Practice Guidelines

Medical Technology Assessment Committee Approval Status – May 2013
National Medical Care Management Committee Approval Status – June 2013
National Quality Management Oversight Committee Approval – July 2013
Provider Advisory Committee Approval – September 2013


To view Summary of Changes and for a printable version, please click here (PDF 485.56 KB).

 

Topic

 

 

Guideline

 

Acute Myocardial Infarction with ST Elevation

2013 ACC/AHA Guidelines for the Management of ST-Elevation Myocardial Infarction

American College of Cardiology Foundation/American Heart Association:

http://content.onlinejacc.org/data/Journals/JAC/926277/11019.pdf

 

Acute Myocardial Infarction without ST Elevation

 

 

2012 Focused Update: ACC/AHA Guidelines for the Management of Patients with Unstable Angina/Non–ST- Elevation Myocardial Infarction (Updating the 2007 Guideline).

American College of Cardiology Foundation/American Heart Association:

http://content.onlinejacc.org/data/Journals/JAC/24742/06004.pdf

 

Asthma

2007 National Asthma Education and Prevention Program Expert Panel Report 3 Guidelines for the Diagnosis and  Management of Asthma

National Heart, Lung and Blood Institute:

www.nhlbi.nih.gov/guidelines/asthma/index.htm

Attention Deficit Hyperactivity Disorder (ADHD)

2007 Practice Parameter for the Assessment and Treatment of Children and Adolescents with Attention Deficit Hyperactivity Disorder

American Academy of Child and Adolescent Psychiatry:

http://www.aacap.org/galleries/PracticeParameters/JAACAP_ADHD_2007.pdf

Autism Spectrum Disorders

UHC Utilization Review Guidelines – Autism Spectrum Disorders

nternal (Knowledge Library):

http://kl/Content/Guidelines%20&%20Clinical%20Policies/Utilization%20Review%20Guidelines/Internal%20and%20External/Autism%20Spectrum%20Disorder_URG.doc

 

External (UnitedHealthcareOnline.com):

https://www.unitedhealthcareonline.com/ccmcontent/ProviderII/UHC/en-US/Assets/ProviderStaticFiles/ProviderStaticFilesPdf/Tools%20and%20Resources/Policies%20and%20Protocols/Medical%20Policies/Medical%20Policies/Autism_Spectrum_Disorder_URG.pdf

Bariatric Surgery

Bariatric Resource Service

Clinical Job Aids

 

·         Laparoscopic Biliopancreatic Diversion with Duodenal Switch (BPD- DS)

·         Laparoscopic Roux-en-Y Gastric Bypass Procedure (LRYGBP) 

·         Laparoscopic Sleeve Gastrectomy (LSG)

·         Laparoscopic Adjustable Gastric Banding (LAGB)

·         Bariatric Conversion Procedures

Bipolar Disorder: Adults

Guideline Watch (November 2005): Practice Guideline for the Treatment of Patients with Bipolar Disorder, 2nd Edition

Bipolar Disorder: Children &  Adolescents

2007 Practice Parameter for the Assessment and Treatment of Children and Adolescents With Bipolar Disorder

American Psychiatric Association

http://psychiatryonline.org/data/Books/prac/Bipolar.watch.pdf

Breast Pumps

UHC Utilization Review Guidelines – Breast Pump

External (UnitedHealthcareOnline.com):

https://www.unitedhealthcareonline.com/ccmcontent/ProviderII/UHC/en-US/Assets/ProviderStaticFiles/ProviderStaticFilesPdf/Tools%20and%20Resources/Policies%20and%20Protocols/Medical%20Policies/Medical%20Policies/Breast_Pump_URG.pdf

Cardiology: CareCore Evidence Based Guidelines

 

Physician Guidelines: Current Evidence-Based Recommendations Regarding Cardiology

Available on unitedhealthcareonline.com  (externally) at:

https://www.unitedhealthcareonline.com/ccmcontent/ProviderII/UHC/en-US/Assets/ProviderStaticFiles/ProviderStaticFilesPdf/Clinician%20Resources/Cardiac/UnitedHealthcare_Cardiology_Notification_Program_Clinical_Criteria_2011.pdf

Cardiovascular Disease: Prevention in Women

 

Effectiveness-Based Guidelines for the Prevention of Cardiovascular Disease in Women 2011 Update:  A Guideline from the American Heart Association

American Heart Association:

http://circ.ahajournals.org/content/123/11/1243.full.pdf

Cardiovascular Disease: Secondary Prevention and Risk Reduction Therapy for Patients with Coronary and Other Atherosclerotic Vascular Disease

2011 AHA/ACC Guidelines for Secondary Prevention and Risk Reduction Therapy for Patients with Coronary and Other Atherosclerotic Vascular Disease

American College of Cardiology/American Heart Association:

http://circ.ahajournals.org/content/124/22/2458.full

 

Cervical Cancer Screening

ACOG Practice Bulletin #109

Cervical Cytology Screening

American College of Obstetricians and Gynecologists

Note: This guideline is not publically available; a user ID and password are required to access the document via: 

http://www.guideline.gov/content.aspx?id=38572

Chemotherapy Observation or Inpatient Hospitalization

UHC Utilization Review Guidelines – Chemotherapy Observation or Inpatient Hospitalization

Internal (Knowledge Library):

http://kl/Content/Guidelines%20&%20Clinical%20Policies/Utilization%20Review%20Guidelines/Internal%20and%20External/Chemo%20Observation_URG.doc

External (UnitedHealthcareOnline.com):

https://www.unitedhealthcareonline.com/ccmcontent/ProviderII/UHC/en-US/Assets/ProviderStaticFiles/ProviderStaticFilesPdf/Tools%20and%20Resources/Policies%20and%20Protocols/Medical%20Policies/Medical%20Policies/Chemotherapy_Observ_and_Inpatient_HospURG.pdf

Cholesterol Management

2004 Third Report of the Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults(Adult Treatment Panel III)

National Heart, Lung and Blood Institute:

http://www.nhlbi.nih.gov/guidelines/cholesterol/index.htm

Chronic Obstructive Lung Disease

2013 Global Initiative for Chronic Obstructive Lung Disease

Global Initiative for Chronic Obstructive Lung Disease (GOLD)

http://www.goldcopd.com

Chronic Stable Angina

 

2007 Chronic Angina Focused Update of the ACC/AHA 2002 Guidelines for the Management of Patients with Chronic Stable Angina

American College of Cardiology / American Heart Association:

http://circ.ahajournals.org/content/116/23/2762.full 

Depression/ Major Depressive Disorder

 

Practice Guideline For The Treatment of Patients With Major Depressive Disorder, Third Edition

American Psychiatric Association:

http://psychiatryonline.org/guidelines.aspx

Diabetes

Standards of Medical Care in Diabetes – 2013

American Diabetes Association:

http://care.diabetesjournals.org/content/36/Supplement_1/S11.full.pdf+html

Dietary Guidelines

Dietary Guidelines for Americans, 2010

U.S. Department of Health and Human Services

http://health.gov/dietaryguidelines/dga2010/DietaryGuidelines2010.pdf

Durable Medical Equipment, Supplies, Prosthetics and Orthotics

UHC Utilization Review Guidelines – Durable Medical Equipment and Related Supplies, Prosthetics and Orthotics

External (UnitedHealthcareOnline.com):

https://www.unitedhealthcareonline.com/ccmcontent/ProviderII/UHC/en-US/Assets/ProviderStaticFiles/ProviderStaticFilesPdf/Tools%20and%20Resources/Policies%20and%20Protocols/Medical%20Policies/Medical%20Policies/DME_URG.pdf

Heart Failure

2013 ACCF/AHA Guideline for the Management of Heart Failure

American College of Cardiology/American Heart Association:

http://content.onlinejacc.org/article.aspx?articleid=1695825

Hemophilia and von Willebrand Disease

Guidelines for the Management of Hemophilia

World Federation of Hemophilia:

http://onlinelibrary.wiley.com/doi/10.1111/j.1365-2516.2012.02909.x/pdf

 

The Diagnosis, Management and Treatment of von Willebrand Disease: 2007 NHLBI Guidelines

National Heart, Lung & Blood Institute:

http://www.nhlbi.nih.gov/guidelines/vwd/index.htm

Human Immuno-deficiency Virus (HIV)

 

 

Primary Care Guidelines for the Management of Persons Infected with Human Immunodeficiency Virus: 2009 Update by the HIV Medicine Association of  the Infectious Diseases Society of America

HIV Medicine Association of  the Infectious Diseases Society of America: http://www.journals.uchicago.edu/doi/pdf/10.1086/605292

Hyperbili-rubinemia in Newborns

American Academy of Pediatrics Clinical Practice Guideline (2004): Management of Hyperbilirubinemia in the Newborn Infant 35 or More Weeks of Gestation

American Academy of Pediatrics:

http://pediatrics.aappublications.org/content/114/1/297.full.pdf

 

American Academy of Pediatrics (2009): Hyperbilirubinemia in the Newborn Infant ≥35 Weeks’ Gestation: An Update with Clarifications

http://pediatrics.aappublications.org/content/124/4/1193.full.pdf

Hypertension

The Seventh Report of the Joint National Committee on Detection, Evaluation and Treatment of High Blood Pressure (2004)

National Heart, Lung and Blood Institute:

http://www.nhlbi.nih.gov/guidelines/hypertension/jnc7full.pdf

Infertility

·         Fertility Preservation Clinical Guidelines

·         ICSI Clinical Guidelines

·         Natural Cycle Clinical Guidelines

·         Ovarian Stimulation Clinical Guideline

·         PCOS Clinical Guidelines

·         Single Embryo Transfer Clinical Guidelines

·         Standard Infertility Workup Clinical Guidelines

·         Treatment of Unexplained Infertility Clinical Guidelines

·         Intrauterine Insemination

External (UnitedHealthcareOnline.com):

https://www.unitedhealthcareonline.com/ccmcontent/ProviderII/UHC/en-US/Assets/ProviderStaticFiles/ProviderStaticFilesPdf/Tools%20and%20Resources/Policies%20and%20Protocols/Medical%20Policies/Medical%20Policies/Inpatient%20Pediatric%20Feeding%20Programs_URG.pdf

Inpatient Pediatric Feeding Programs

UHC Utilization Review Guidelines – Inpatient Pediatric Feeding Programs

Maternal Support Program Clinical Guidelines

 

 

 

 

 

 

 

 

 

 

 

 

 

·         Anemia and Pregnancy Clinical Guidelines

·         Cervical Insufficiency Clinical Guidelines

·         Avoidance of Elective Deliveries before 39 Weeks Gestation

·         Assessment of Fetal Well Being

·         Administration of 17P for Prevention of Preterm Birth

·         Breast Milk Feeding

·         Coagulation Disorders in Pregnancy

·         Gastrointestinal Disease in Pregnancy

·         Gestational Diabetes

·         Intrauterine Growth Restriction (IUGR)

·         Malignancy and Pregnancy

·         Maternal and Fetal Infections

·         Maternal Nutrition and Obesity

·         Multiple Gestation

·         Placenta Previa

·         Diseases of the Liver Biliary System and Pancreas in Pregnancy

·         Post-Term Pregnancy

·         Pregnancy Related Hypertension

·         Premature Rupture of Membranes (PROM)

·         Preterm Labor and Birth

·         Respiratory Disease in Pregnancy

·         Thromboembolic Disease in Pregnancy

·         Thyroid Disease in Pregnancy

·         Trial of Labor after C-Section (TOLAC) and Vaginal Birth after C-Section (VBAC)

·         Maternal Cardiovascular Disorders Associated with Pregnancy

·         Neurologic Disorders in Pregnancy

·         Skin and Pregnancy

·         Intimate Partner Violence

·         Hemolytic Disease of the Fetus and Newborn

·         Endocrine Disorders in Pregnancy

MCG™ Care Guidelines

MCG™ Care Guidelines, 17th Edition

MCG™ Care Guidelines

http://www.careguidelines.com

Obesity

American Academy of Pediatrics (AAP) Obesity Portal

http://www2.aap.org/obesity/health_professionals.html?technology=0

 

The Practical Guide: Identification, Evaluation and Treatment of Overweight and Obesity in Adults, October 2000

National Heart, Lung and Blood Institute

http://www.nhlbi.nih.gov/guidelines/obesity/prctgd_c.pdf

Oncology

 

National Comprehensive Cancer Network (NCCN) Clinical Practice Guidelines in Oncology

National Comprehensive Cancer Network: http://www.nccn.org/index.asp

Organ Transplantation

 

Transplant Review Guidelines: Solid Organ and Stem Cell Transplantation

External (UnitedHealthcareOnline.com):

https://www.unitedhealthcareonline.com/ccmcontent/ProviderII/UHC/en-US/Assets/ProviderStaticFiles/ProviderStaticFilesPdf/Tools%20and%20Resources/Policies%20and%20Protocols/Medical%20Policies/Clinical%20Guidelines/Transplant_Review_Guidelines.pdf

Perinatal Care

 

 

 

American Academy of Pediatrics and the American College of Obstetricians and Gynecologists, Sixth Edition, Guidelines for Perinatal Care 

American College of Obstetricians and Gynecologists

Note: This resource is not publically available; a user ID and password are required to access the document via: 

http://www.acog.org/Resources_And_Publications

 

Alternative site: To view a summary of the guidelines please click here (PDF 164.77 KB) 

Physical Activity

2008 Physical Activity Guidelines for Americans

U.S. Department of Health and Human Services

http://www.health.gov/paguidelines/pdf/paguide.pdf

Preventive Pediatric Health Care Screening

2009 Recommendations for Preventive Pediatric Health Care:  American Academy of Pediatrics Screening Guidelines (periodicity schedule)

American Academy of Pediatrics:

http://brightfutures.aap.org/pdfs/AAP%20Bright%20Futures%20Periodicity%20Sched%20101107.pdf

Preventive Services

 

 

 

Guide to Clinical Preventive Services, 2010-2011: Recommendations of the U.S. Preventive Services Task Force

Agency for Healthcare Research and Quality: http://www.ahrq.gov/clinic/pocketgd.htm

Note: Although the USPSTF concluded that the current evidence is insufficient to assess the additional benefits and harms of digital mammography instead of film as a screening modality for breast cancer, before the age of 50, UnitedHealthcare will cover this as a preventive health service.

Propranolol Treatment for Infantile Hemangioma

UHC Utilization Review Guidelines – Propranolol Treatment for Infantile Hemangiomas: Inpatient Protocol

External (UnitedHealthcareOnline.com):

https://www.unitedhealthcareonline.com/ccmcontent/ProviderII/UHC/en-US/Assets/ProviderStaticFiles/ProviderStaticFilesPdf/Tools%20and%20Resources/Policies%20and%20Protocols/Medical%20Policies/Medical%20Policies/PropranololURG.pdf

Radiology:

CareCore Evidence Based Guidelines Commercial/Medicaid

Physician Guidelines: Current Evidence-Based Recommendations Regarding Imaging 2013 Commercial/Medicaid

External (UnitedHealthcareOnline.com):

Evidence-Based Clinical Guidelines - Imaging 2013

Radiology:

CareCore Evidence Based Guidelines Medicare & Retirement

Physician Guidelines: Current Evidence-Based Recommendations Regarding Imaging 2013 Medicare & Retirement

External (UnitedHealthcareOnline.com):

Physician Guidelines: Current Evidence-Based Recommendations Regarding Imaging 2013 Medicare & Retirement

Schizophrenia

Guideline Watch (September 2009): Practice Guideline for the Treatment of Patients with Schizophrenia

American Psychiatric Association/ PsychiatryOnline Guideline Watch:

http://psychiatryonline.org/content.aspx?bookid=28&sectionid=1682213#501001

Sickle Cell Disease

The Management of Sickle Cell Disease, 4th Edition National Heart, Lung, and Blood Institute (NHLBI)

National Heart, Lung and Blood Institute:

http://www.nhlbi.nih.gov/health/prof/blood/sickle/sc_mngt.pdf

Spinal Stenosis

 

 

2011 Evidence-Based Clinical Guidelines for Multidisciplinary Spine Care

Diagnosis and Treatment of Degenerative Lumbar Spinal Stenosis

North American Spine Society:

http://www.spine.org/Documents/LumbarStenosis11.pdf

Substance Use Disorders

Guideline Watch (April 2007): Practice Guideline for the Treatment of Patients with Substance Use Disorders

American Psychiatric Association/ PsychiatryOnline Guideline Watch: http://focus.psychiatryonline.org/article.aspx?articleid=52296

Tobacco Use

Treating Tobacco Use and Dependence: 2008 Update

U.S. Department of Health and Human Services

http://www.ncbi.nlm.nih.gov/books/NBK63952/

 

Supplement: Corrections and Additions to the 2008 Guideline Update

http://www.ahrq.gov/professionals/clini cians-providers/guidelines- recommendations/tobacco/clinicians/u pdate/correctadd.html