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Providers

Care Guidelines

Our Quality Management department is responsible for developing and monitoring systems that support our commitment to providing quality care and services to our members. This includes evaluating our performance based on clinical standards.

We encourage our participating providers to take an active role in the ongoing management of member care, particularly members with chronic conditions. We also seek to ensure the coordination of care across specialties and care settings and encourage our practitioners to discuss health conditions with their patients. Providers that work with our pediatric members should also review the EPSDT/Bright Futures page for additional resources.

Care Guidelines

ADHD

ADHD in Children and Adolescents
American Academy of Pediatrics

Asthma - Adult and Child

Asthma Care Quick Reference
National Heart, Lung and Blood Institute

Breast Cancer Screening

Recommendation: Breast Cancer: Screening
U.S. Preventive Services Task Force

Chronic Obstructive Pulmonary Disease (COPD)

Chronic Obstructive Pulmonary Disease: Screening
U.S. Preventive Services Task Force

2023 GOLD Report
Gold Initiative for Chronic Obstructive Lung Disease

Medication Regimens for Managing COPD Exacerbations
National Library of Medicine

Diabetes

Referring Patients to DSMES
Centers for Disease Control and Prevention

Diabetes - Adult and Child

Standards of Care in Diabetes
American Diabetes Association

Opioid Prescribing

Opioid Prescribing Guidelines
Philadelphia Department of Public Health/ Department of Behavioral Health and Intellectual disABILITY Services

Guidelines for Prescribing Opioids for Chronic Pain
Centers for Disease Control and Prevention

Postoperative Opioid Prescribing Guidelines
City of Philadelphia, Department of Public Health

Postoperative Opioid Prescribing Guidelines: Background for Surgeons
City of Philadelphia, Department of Public Health

Treating Chronic Non-Cancer Pain
Commonwealth of Pennsylvania

Pediatric Lead Levels

Lead Exposure
American Academy of Pediatrics

Perinatal Care

Alliance for Innovation on Maternal Health
AAP and The American College of Obstetricians and Gynecologists

Sexually Transmitted Infections

STI Treatment Guidelines Update
Centers for Disease Control and Prevention

Smoking Cessation

Cessation Materials for State Tobacco Control Programs
Centers for Disease Control and Prevention

Upper Respiratory Infections

Appropriate Antibiotic Use
Centers for Disease Control and Prevention

Respiratory Tract Infections Resources
American Academy of Family Physicians

Preventive Care Resources

Social Determinants of Health: Tools for Putting SDOH Into Action (CDC) Immunizations: PA Medical Assistance Bulletin: Immunization Coverage Update CDC Birth - 18 Years Immunization Schedule AAP Immunization Schedule AAFP Immunization Schedules CDC Catch-Up Immunization Schedule for Children and Adolescents CDC Adult Immunization Schedule (19 Years or Older) Tools and Resources \| ACOG Immunize.org Rural Disparities in HPV Vaccination HPV Vaccination Starting at Age 9	Immunizations - Individual and Family Plans: Child Immunization Schedule Adult Immunization Schedule Depression: Patient Depression Questionnaire (PHQ-9) Edinburgh Postnatal Depression Scale (EPDS) Patient Health Questionnaire - 2 (PHQ-2) U.S. Preventive Services Task Force: A and B Recommendations Other Resources: Boys Body Mass Index-for-age Percentiles Girls Body Mass Index-for-age Percentiles Healthy Active Living For Families American Academy of Family Physicians Resources for Families

Social Determinants of Health:

Tools for Putting SDOH Into Action (CDC)

Immunizations:

Immunizations - Individual and Family Plans:

Depression:

U.S. Preventive Services Task Force:

A and B Recommendations

Other Resources:

Update to Colorectal Cancer Screening Guidelines

NCQA recently updated the Measurement Year (MY) 2023 HEDIS guidelines and lowered the recommended age range for screening to ages 45-75. Jefferson Health Plans will implement this change for the Medicare QCP program in Measurement Year 2023.

Preventive Care Guidelines

Jefferson Health Plans encourages providers to discuss preventive care with their patients. The list below demonstrates examples of evidence-based guidelines.