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.

View patient decision aids

Clinical practice guidelines

Guideline Consensus document
Asthma
(PDF, 40 KB)
AWARE - Alliance Working for Antibiotic Resistance Education (Pediatric/Adult)
(PDF, 467 KB)

2007/2008 Updated References for AWARE Compendia

Acute Bacterial Sinusitis:
O'Brien K., et al. Acute sinusitis-Principles of judicious use of antimicrobial agents. Pediatrics. 1998; 101:174-177.
Piccirillo JF. Clinical Practice: Acute Bacterial Sinusitis. N Engl J Med. 2004 Aug 26; 351(9):902-10.
Sinus and Allergy Health Partnership. Antimicrobial Treatment Guidelines fort Acute Bacterial Rhinosinusitis. Executive Summary. Supplement Otolaryngology-Head and Neck Surgery, 2004; 130:1-45.
Snow V., et al. Clinical Practice Guideline Part 1: Principles of Appropriate Antibiotic Use of Acute Sinusitis in Adults: Background. Ann Internal Med. 2001; 134:498-505.
Subcommittee on Management of Sinusitis and Committee on Quality Improvement. Clinical practice guidelines: Management of sinusitis. Pediatrics. 2001; 108:798-808.

Otitis Media:
Ganiats T., et al. Clinical practice guidelines: Diagnosis and management of acute otitis media. Pediatrics. 2004; 113: 1451-1465.

Pharyngitis:
Bisno A., et al. Diagnosis and management of Group A Streptococcal pharyngitis: A Practice guideline- ISDA. Clin Infect Dis. 1997; 25:574-583.
Cooper R., et al. Principles of appropriate antibiotic use for acute pharyngitis in adults: Background. Ann Intern Med. 2001; 134:509-517.
Institute of Clinical Systems Improvement. Executive summary: Acute pharyngitis health care guidelines. Accessed on May 2005 at http://www.icsi.org
Linder J., et al. Antibiotic treatment in children with sore throat. JAMA. November 2005; 294:2315-2322.
Schwartz B., et al. Pharyngitis-Principles of judicious use of antimicrobial agents. Pediatrics. 1998; 101:171-174.

Non-specific Cough Illness/Acute Bronchitis:
Gonzales R., et al. Principles of appropriate antibiotic use for treatment of acute respiratory tract infections in adults. Ann of Emerg Med. 2001; 37:690-697.
Gonzales R., et al. Principles of appropriate antibiotic use fro treatment of uncomplicated acute bronchitis: Background. Ann Intern Med. 2001; 134:521-529.
Hootan T., et al. Antimicrobial resistance: A Plan of action for community practice. Am Fam Physician. 2001; 63:1034-1039.
O'Brien K., et al. Cough Illness/bronchitis: Principles of judicious use of antimicrobial agents. Pediatrics. 1998; 101:178-181.
Wenzel RP., et al. Acute bronchitis. NEJM 2006;355:2125-30.

Non-specificURI/Bronchiolitis:
Colgan R., Appropriate antimicrobial prescribing. Approaches that limit antibiotic resistance. Am Fam Physician. 2001; 64:999-1004.
Dowell S., et al. Appropriate use of antibiotics for URIs in children: Part II. Cough, pharyngitis and the common cold. Am Fam Physician. 1998; 58:1335-1342.
Dowell S., et al. Principles of judicious use of antimicrobial agents for pediatric upper respiratory tract infections. Pediatrics. 1998; 101:163-165.
Gonzales R., et al. Principles of appropriate antibiotic use for treatment of acute respiratory tract infections in adults: Background, specific aims and methods. Clinical practice guidelines. Ann Intern Med. 2001; 134:479-486.
Gonzales R., et al. Principles of appropriate antibiotic use for treatment of acute respiratory tract infections in adults: Background. Clinical practice guidelines part 2. Ann Intern Med. 2001; 134:490-494.
Kelly LF. Pediatric cough and cold preparations. Pediatr Rev. 2004;25:115-123.

Community Acquired Pneumonia
Mandell LA., et al. Infectious Disease Society of America/American Thoracic Society Consensus Guidelines on the management of community-acquired pneumonia in adults. CID. 2007; 44:S27-72.
Medical Letter, July 2007; 49(1266):62-64.
Chronic Obstructive Pulmonary Disease (COPD)
(PDF, 38 KB)
Coronary Artery Disease (CAD)
(PDF, 59 KB)
Depression for children and adolescents
(PDF, 226 KB)

Content provided by the American Academy of Child and Adolescent Psychiatry (AACAP)

Additional information: Patient and physician education materials
Diabetes
(PDF, 41 KB)
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.
Fick DM, et al., Updating the Beers criteria for potentially inappropriate medication use in older adults: results of a US consensus panel of experts. Arch Intern Med 2003;163:2716-2724.
Curtis LH, Ostbye T, Sendersky V, et al., Inappropriate prescribing for elderly Americans in a large outpatient population. Arch Intern Med 2004;164:1621-25.
Heart failure
(PDF, 47 KB)

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 in Collaboration With the Society of Thoracic Surgeons

2017 ACC/AHA/HFSA Focused Update of the 2013 ACCF/AHA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Failure Society of America

2016 ACC/AHA/HFSA Focused Update on New Pharmacological Therapy for Heart Failure: An Update of the 2013 ACCF/AHA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Failure Society of America

Acute Myocardial Infarction with ST-Elevation
2015 ACC/AHA/SCAI Focused Update on Primary Percutaneous Coronary Intervention for Patients With ST-Elevation Myocardial Infarction: An Update of the 2011 ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention and the 2013 ACCF/AHA Guideline for the Management of ST-Elevation Myocardial Infarction

Acute Myocardial Infarction without ST-Elevation
2014 AHA/ACC Guideline for the Management of Patients with Non-ST-Elevation Acute Coronary Syndromes: A Report of the American College of Cardiology/ American Heart Association Task Force on Practice Guidelines

Stable Ischemic Heart Disease
2014 ACC/AHA/AATS/PCNA/SCAI/STS Focused Update of the Guideline for the Diagnosis and Management of Patients With Stable Ischemic Heart Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines, and the American Association for Thoracic Surgery, Preventive Cardiovascular Nurses Association, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons

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)
Advisory Committee on Immunization Practices and Centers for Disease Control and Prevention
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, 1.6 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