While ApexHealth does not use Clinical Practice Guidelines (CPGs) as criteria for medical necessity determinations, we do use them to support our goals of quality health care and improved member outcomes. We adopt CPGs from recognized sources, such as the American Diabetes Association, American Heart Association, U.S. Preventive Services Task Force and American College of Obstetricians and Gynecologists. We currently have CPGs for the provision of acute, chronic, and preventive services, which are reviewed annually.
Adult immunizations
Centers for Disease Control and Prevention (CDC)
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
Atrial fibrillation guidelines
AHA/ACC/Heart Rhythm Society
2019 AHA/ACC/HRS Focused Update of the 2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society
Covid-19
National Institute of Health (NIH) Covid-19 Treatment Guidelines
(The NIH updates this guideline continually, as it obtains new information about managing Covid-19). The guideline is approved in its most current format.
Guideline for the Management of Covid-19
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), 2021 Report
Depression
American Psychiatric Association (APA) Clinical Practice Guideline for the Treatment of Depression Across Three Age Cohorts American Psychological Association Guideline Development Panel for the Treatment of Depressive Disorders
APA Clinical Practice Guideline for the Treatment of Depression Across Three Age Cohorts
Diabetes
American Diabetes Association
Standards of Medical Care in Diabetes – 2021
Heart failure
The American College of Cardiology/American Heart Association Task Force on Performance Measures
2020 ACC/AHA Clinical Performance and Quality Measures for Adults With Heart Failure
Hypertension
2020 International Society of Hypertension
2020 International Society of Hypertension Global Practice Guidelines
Kidney disease
National Kidney Foundation
Guidelines and Commentaries – Evidence-based clinical practice guidelines for all stages of chronic kidney disease
Opioid Guidelines
ICSI
Pain: Assessment, Non-Opioid Treatment Approaches and Opioid Management 8th Edition, August 2017: Version 2
Health and Human Services (HHS)
HSS Guide for Clinicians on the Appropriate Dosage Reduction or Discontinuation of Long-Term Opioid Analgesics
Oxygen Therapy (added July 2021)
American Thoracic Society
Home Oxygen Therapy for Adults with Chronic Lung Disease. An Official American Thoracic Society Clinical Practice Guideline
Preventive care
U.S. Preventive Services Task Force
USPSTF Guidelines – All Topics
Primary Prevention of Cardiovascular Disease and Stroke
ACC/AHA Task Force on Clinical Practice Guidelines
2019 ACC/AHA Guideline on the Primary Prevention of Cardiovascular Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines
Sepsis
The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3)
The Third International Consensus Definitions for Sepsis and Septic Shock
Sickle cell anemia
NIH
Evidence-Based Management of Sickle Cell Disease: Expert Panel Report 2014
Sleep apnea
American Society of Anesthesiologists Task Force on Perioperative Management of Patients with Obstructive Sleep Apnea
Practice Guidelines for the Perioperative Management of Patients with Obstructive Sleep Apnea
American Academy of Sleep Medicine Clinical Practice Guidelines/Journal of Clinical Sleep Medicine (aasm.org)
Treatment of Adult Obstructive Sleep Apnea with Positive Airway Pressure 2019 Update
Valvular heart disease
American College of Cardiology/American Association Joint Committee on Clinical Practice Guidelines
2020 ACC/AHA Guideline for the Management of Patients with Valvular Heart Disease
Well-woman routine care
The American College of Obstetricians and Gynecologists (ACOG)
Recommendations for Well-Woman Care 2021