Practice Guidelines Overview

​​​​​

Practice guidelines are intended to assist providers and members in clinical decision-making and to improve care. They also document evidence available to determine appropriate care. Guidelines are not meant to dictate clinical practice but are evidenced based and a good place to go for guidance in the care of mental disorders. Providers need to keep in mind that each member is an individual and that each provider has their own approach to delivery of care. Therefore, all treatment must be individualized to the individual. Good clinical judgment should be used in all situations and at times will supersede practice guidelines.

Cardinal Innovations will use practice guidelines and clinical standards to evaluate effectiveness and appropriateness of care. The utilization management unit performs this function. Care that is deemed outside the norm will be evaluated by these guidelines. Providers may also use these guidelines as a road map for effective evidence based care. We also intend members to use these guidelines to help them make decisions about treatment.

Good examples of the use of guidelines are the following:

     

  1. A provider is treating an individual who suffers from schizophrenia who is still psychotic after a trial of three antipsychotics. The guidelines clearly show that the next step is for the individual to be placed on Clozaril. The provider should make arrangements for the individual to receive Clozaril. If the case were reviewed by UR, we would require that the individual be placed on Clozaril if there were no contraindications and the individual was willing.


  2. An individual with depression is being treated with Cognitive Behavioral Therapy (CBT). The individual is not sure if this is a valid treatment for this illness. The guidelines do recommend CBT for the treatment of depression. They would also notice that medication is recommended for depression. This would allow for the individual to make an informed decision about their care.
  3.  

Many of these guidelines have been adopted from the American Psychiatric Association. Cardinal Innovations staff and consultants who are considered experts in their fields have developed several of these guidelines where national guidelines were not available. All of the guidelines have been reviewed and accepted by our Clinical Advisory Council that consists of staff, practitioners and members.

Please use these guidelines as a road map and an educational tool. They are best used when individuals are not achieving improvement goals.

Cardinal Innovations will continue to monitor, revise, and add to this list of guidelines.

 

Ranota T. Hall, MD, Chair
EVP and Chief Medical Officer
Cardinal Innovations Healthcare​