Clinical practice guidelines and shared decision-making aids
Blue Shield of California is committed to improving health with optimal outcomes. Clinical practice guidelines help by providing a summary of evidence-based recommendations for the evaluation and treatment of select common acute and chronic conditions.
Clinical practice guidelines focus on important aspects of care with recognized and measurable best practices for high-volume diagnoses.
The basis of the guidelines includes a variety of sources that are nationally recognized, or evidence-based, or are expert consensus documents. Additional points have been included where medical literature and expert opinion are noted.
Network physician involvement is a crucial part of the guideline development, as well as adoption for the organization after approval by Blue Shield committees.
Shared decision-making aids
Providers can also utilize certified decision-making tools based on their specialty. These tools assist physicians in discussing treatment options with their members (conservative to invasive) and include information on risk and potential outcomes. Patient decision-making tools aids are available on the topics of maternity and labor/delivery; total joint replacement and spine care; end of life care; and cancer screening.
Clinical practice guidelines
| Guideline | Consensus document |
|---|---|
| Asthma (PDF, 40 KB) |
NHLBI Guidelines for the diagnosis and management of asthma (Expert Panel Report 3), 2012
|
| AWARE – Alliance Working for Antibiotic Resistance Education (Pediatric/Adult) (PDF, 467 KB) |
2007/2008 Updated References for AWARE Compendia Acute Bacterial Sinusitis: Otitis Media: Pharyngitis: Non-specific Cough Illness/Acute Bronchitis: Non-specificURI/Bronchiolitis: Community Acquired Pneumonia
|
| Chronic Obstructive Pulmonary Disease (COPD) (PDF, 38 KB) |
Global Initiative for Chronic Obstructive Lung Disease 2023 Report Global Initiative for Chronic Obstructive Lung Disease 2022 Report ICSI Chronic Obstructive Pulmonary Disease Guideline GOLD Global Initiative for Chronic Obstructive Lung Disease ATS Standards for the Diagnosis and Care of Patients with Chronic Pulmonary Obstructive Disease
|
| Coronary Artery Disease (CAD) (PDF, 59 KB) |
ACC/AHA Guideline on the Assessment of Cardiovascular Risk, 2013 2014 Evidence-Based Guideline for the management of High Blood Pressure in Adults (JNC 8), 2014 2013 AHA/ACC Guideline on Lifestyle Management to Reduce Cardiovascular Risk, 2013
|
| Depression for children and adolescents |
Content provided by the American Academy of Child and Adolescent Psychiatry (AACAP) Additional information: Patient and physician education materials
|
| Diabetes (PDF, 41 KB) |
ADA Standards of Medical Care in Diabetes, 2022 Summary of Revisions: Standards of Medical Care in Diabetes, 2022 ADA Standards of Medical Care in Diabetes, 2020 ADA Standards of Medical Care in Diabetes, 2019 ADA National Standards for Diabetes Self-Management Education and Support, 2014, January
|
| Drugs to be avoided by the elderly (PDF, 79 KB) |
Zhan, C et al., Potentially inappropriate medication use in the community dwelling elderly. JAMA 2001;286:2823-2829.
|
| Heart failure (PDF, 47 KB) |
Acute Myocardial Infarction with ST-Elevation Acute Myocardial Infarction without ST-Elevation ACCF/AHA Guideline for the Management of Heart Failure, 2017 October 2016 ACC/AHA/HSFA Focused Update on New Pharmacological Therapy for Heart Failure
|
| Preventive health |
U.S. Preventive Services Task Force (USPSTF)
|
| Pediatric Attention-Deficit/Hyperactivity Disorder (PDF, 247 KB) |
Content provided by the American Academy of Child and Adolescent Psychiatry (AACAP) Additional information: Physician education materials (PDF, 30 KB)
|
| Treatment of Patients With Major Depressive Disorder, Third Edition (PDF, 2 MB) |
Content provided by American Psychiatric Association
|
| Treatment of Patients With Substance Use Disorders, Second Edition (PDF, 2 MB) |
Content provided by American Psychiatric Association
|
Drug formulary, policy and forms
Search our drug formulary database, get prior authorization forms, and find information on oral and topical drugs, home-injectable drugs and more.
Policies and standards
Find medication policies information and standards for HIPAA transactions, medical records and more.
Patient care resources and programs
Find information to help your members, such as language assistance resources, patient education materials, member rights and responsibilities, and more.
Medical care solutions for Blue Shield Promise Medicare, Medi-Cal and Cal MediConnect providers
Learn about Blue Shield Promise requirements, policies and procedures.