Doctors HealthCare Plans, Inc. Your Health, Our Commitment
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Clinical Practice Guidelines

Clinical practice guidelines are resources* for Doctor’s HealthCare Plans, Inc. (DHCP) contracted physicians and other DHCP contracted healthcare professionals. DHCP periodically monitors compliance with nationally recognized clinical practice guidelines. DHCP has adopted the following guidelines:


Adult immunizations

Centers for Disease Control and Prevention
Recommended immunization schedule for adults aged 19 years or older, United States 2021

Asthma care

Global Initiative for Asthma (GINA)
2021 GINA Report: Global Strategy for Asthma Management and Prevention

Atherosclerotic cardiovascular disease

American Heart Association (AHA) and the American College of Cardiology Foundation (ACC)
AHA/ACCF Secondary Prevention and Risk Reduction Therapy for Patients with Coronary and Other Atherosclerotic Vascular Diseases: 2011 Update

Back Pain (New for 2020)

Institute for Clinical Systems Improvement
Health Care Guideline: Adult Acute and Subacute Low Back Pain 16th Edition (March 2018)

Breast cancer screening

U.S Preventive Services Task Force (January 2016-an update for this topic is in progress (2021))
Recommendation: Screening for Breast Cancer | United States Preventive Services Taskforce (uspreventiveservicestaskforce.org)

Cholesterol treatment

2018 AHA/ACC/American Association of Cardiovascular and Pulmonary Rehabilitation (AACVPR)/ American Academy of Physician Assistants (AAPA) /Association of Black Cardiologists (ABC) /American College of Preventive Medicine (ACPM) / American Diabetes Association (ADA) / American Geriatric Society (AGS) / American Pharmacist Association (AphA) / American Society of Preventive Cardiology (ASPC) / National Lipid Association (NLA) / Preventive Cardiovascular Nurses Association (PCNA)
https://www.ccjm.org/content/87/4/231

Chronic obstructive pulmonary disease (COPD)

Global Initiative for Chronic Obstructive Lung Disease (GOLD)
Global Strategy for the Diagnosis, Management and Prevention of Chronic Obstructive Pulmonary Disease (COPD), 2020 Update

Colorectal Cancer Screening Guideline

American Cancer Society Guideline for Colorectal Cancer Screening
Guideline for Colorectal Cancer Screening

Depression

Institute for Clinical Systems Improvement (ICSI): Depression, Adult in Primary Care (March 2016)
Depression, Adult in Primary Care, 17th edition (March 2016)

Diabetes

American Diabetes Association
Standards of Medical Care in Diabetes – 2020

Heart failure

2017 ACC/AHA/Heart Failure Society of America (HFSA) Task Force on Clinical Guidelines
2017 ACC/AHA/HFSA Focused Update of the 2013 ACCF/AHA Guideline for the Management of Heart Failure

Heart Risk Calculator

American College of Cardiology Foundation
Heart risk calculator

Hypertension

ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA
2017 Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults. A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines.

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Kidney disease

National Kidney Foundation (Note: These guidelines are updated on an ongoing basis by the owning organization) Guidelines and Commentaries – Evidence-based clinical practice guidelines for all stages of chronic kidney disease

Medical records documentation guidelines

Doctor’s HealthCare Plans, Inc. has adopted guidelines based on accreditation and state medical record documentation requirements. Refer to the Doctor’s HealthCare Plans, Inc. provider manual at: https://www.Doctor’s HealthCare Plans, Inc.healthplans.com/Doctor’s HealthCare Plans, Inc.-providers/forms.

Obesity screening in adults

U.S. Preventive Services Task Force
Recommendation: Weight Loss to Prevent Obesity-Related Morbidity and Mortality in Adults: Behavioral Interventions | United States Preventive Services Taskforce (uspreventiveservicestaskforce.org)

Opioid Guidelines (New for 2020)

Institute for Clinical Systems Improvement (ICSI)
Pain Assessment, Non-Opioid Treatment Approaches and Opioid Management 8th Edition, August 2017: Version 2
Health and Human Services (HHS)
HHS Guide for Clinicians on the Appropriate Dosage Reduction or Discontinuation of Long-Term Opioid Analgesics

Preventive care

U.S. Preventive Services Task Force
Recommendation: BRCA-Related Cancer: Risk Assessment, Genetic Counseling, and Genetic Testing | United States Preventive Services Taskforce (uspreventiveservicestaskforce.org)

Primary Prevention of Cardiovascular Disease and Stroke

American College of Cardiology (ACC)/American Heart Association (AHA) Task Force on Clinical Practice Guidelines
2019 Guideline on the Primary Prevention of Cardiovascular Disease Guideline Made Simple2019 ACC/AHA Guideline on the Primary Prevention of Cardiovascular Disease: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines (ahajournals.org)

Sickle Cell Anemia (New for 2020)

National Institute for Health (NIH)
Evidenced-Based Management of Sickle Cell Disease: Expert Panel Report 2014

Smoking cessation

Agency for Healthcare Research and Quality
Treating Tobacco Use and Dependence: 2008 Update—Clinical Practice Guideline

Valvular heart disease

AHA/ACC Task Force on Clinical Practice Guidelines
2017 Focused Update of the 2014 AHA/ACC Guideline for the Management of Patients with Valvular Heart Disease

Well-woman routine care

The American College of Obstetricians and Gynecologists (ACOG)
2021 Recommendations for Well-Woman Care

 

*Doctor’s HealthCare Plans, Inc. (DHCP) publishes medical guidelines from a number of well-respected national sources. These guidelines may have some differences in recommendations. Information contained in the guidelines is not a substitute for a physician’s or other healthcare professional’s clinical judgment and is not always applicable to an individual. Therefore, the physician or healthcare professional and DHCP member should work in partnership in the decision-making process regarding the member’s treatment. Furthermore, using this information will not guarantee a specific outcome for each member. None of the information in the guidelines is intended to interfere with or prohibit clinical decisions made by a treating physician or other healthcare professional regarding medically available treatment options for DHCP members.

Publication of these guidelines is not a promise or guarantee of coverage. Your DHCP covered members should review their Evidence of Coverage for detailed information.

Links to other websites are provided for your convenience and information only and do not constitute or imply DHCP’s endorsement of these sites, products or services described on these sites, or of any other material contained therein. When you select a link to an external website, you are leaving the DHCP website and are subject to the privacy and security policies of the sponsors of that external website DHCP disclaims responsibility for their content and accuracy.

 

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Last Updated: 05/19/2021

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