Change Healthcare Clinical Evidence Classification
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1 InterQual Specialty Referral Criteria: Pulmonary Disorders Bibliography Change Healthcare Clinical Evidence Classification References cited in the clinical content are classified according to the type of evidence presented. The class ratings, I through V, are intended to provide a classification of the evidence but are not necessarily hierarchical. Classifications appear in parentheses at the end of each reference. References followed by an (NC) are not classified; examples include pre-published research or information from government, manufacturer, laboratory, or patient education websites. Classification Class I Class II Class III Class IV Class V Type of Evidence Meta-analysis, technology assessment, or systematic review Randomized controlled trial Observational or epidemiologic study Evidence-based guideline Expert opinion, panel consensus, literature review, text or reference book, descriptive study, case report, or case series Class I Class I sources synthesize the results of multiple studies. When quantitative synthesis is possible, meta-analyses can provide a more accurate estimate of the effect or association size than individual smaller studies can. A Class I study that finds insufficient evidence to support or refute an intervention (due to a lack of appropriate primary research) is inconclusive. A potential weakness of Class I studies is that they may only assess published research, potentially leaving their findings vulnerable to publication bias Change Healthcare, LLC and/or its subsidiaries. All Rights Reserved. Produced in Cork, Ireland. 1
2 Class II A randomized controlled trial (RCT) is an experimental study design in which subjects are randomly assigned to an intervention or a control group. An RCT is the gold standard for testing cause and effect relationships. Intention-to-treat analysis should be performed to account for missing data points. Class III Observational or epidemiologic studies can suggest an association between events or findings. These associations cannot be used to establish causality. Cross-sectional, cohort, and casecontrol studies are all used to identify possible risk factors. Cross-sectional studies are also used to determine the prevalence of a condition. Cohort studies are used to study incidence, the natural history of a condition, prognosis after a specific exposure, and associated harms. Nonrandomized controlled trials are sometimes used when randomization is impossible or unethical. Class IV Evidence-based guidelines are systematically developed recommendations for clinical practice. Evidence-based guidelines identify the methodology used to gather the evidence on which the recommendations are based. Usually, a grading system for both the quality of the evidence and the strength of the recommendations is provided. Guidelines that are evidencebased may also contain consensus recommendations in areas where evidence is lacking, but these recommendations are clearly identified and appropriately graded. Class V Class V references may be the best information in the absence of other evidence. Expert opinion, panel consensus, literature reviews, and descriptive studies (case reports or case series) are subject to significant bias. A case series with comparison to historical controls can be plagued with missing data, and data extraction inconsistencies are common. The use of historical controls does not address how the diagnosis of disease or its treatment has evolved over time with newer technologies or medication. Text book information may be out of date by the time the book is published. Comparative Effectiveness Research (CER) Citations are designated with the CER label as part of the evidence classification if the article cited is one of the following: 1. A clinical trial or other clinical study that directly compares two or more health care interventions for the same clinical scenario. 2. A systematic review that compares two or more health care interventions by synthesizing the research from previous clinical studies Change Healthcare, LLC and/or its subsidiaries. All Rights Reserved. Produced in Cork, Ireland. 2
3 Bibliography Agnelli and Becattini. Acute pulmonary embolism. N Engl J Med (3): (V) American Academy of Allergy. Consultation and referral guidelines citing the evidence: how the allergist-immunologist can help. J Allergy Clin Immunol (2 Suppl Consultation):S (IV) American College of Radiology. ACR appropriateness criteria: suspected pulmonary embolism. Reston, VA: American College of Radiology; (IV) American Thoracic Society (ATS) and Centers For Disease Control and Prevention (CDC). Targeted tuberculin testing and treatment of latent tuberculosis infection. American Thoracic Society. MMWR Recomm Rep (RR-6):1-51. (IV) Aurora. Practice Parameters for the Surgical Modifications of the Upper Airway for Obstructive Sleep Apnea in Adults. Sleep (10): (IV CER) Bapoje et al. Preoperative evaluation of the patient with pulmonary disease. Chest (5): (V) Bettmann et al. ACR Appropriateness Criteria(R) acute chest pain--suspected pulmonary embolism. J Thorac Imaging (2):W (IV) Braman. Chronic cough due to chronic bronchitis: ACCP evidence-based clinical practice guidelines. Chest (1 Suppl):104S-15S. (IV) Braman. Postinfectious cough: ACCP evidence-based clinical practice guidelines. Chest (1 Suppl):138S-146S. (IV) Chang et al. Gastro-oesophageal reflux treatment for prolonged non-specific cough in children and adults. Cochrane Database Syst Rev :CD (I) Chung et al. High STOP-Bang score indicates a high probability of obstructive sleep apnoea. Br J Anaesth (5): (III) Condliffe et al. Management dilemmas in acute pulmonary embolism. Thorax (2): (V) Connors et al. Interstitial lung disease associated with the idiopathic inflammatory myopathies: what progress has been made in the past 35 years? Chest (6): (V) Dicpinigaitis. Angiotensin-converting enzyme inhibitor-induced cough: ACCP evidence-based clinical practice guidelines. Chest (1 Suppl):169S-73S. (IV) Dicpinigaitis. Chronic cough due to asthma: ACCP evidence-based clinical practice guidelines. Chest (1 Suppl):75S-9S. (IV) Epstein et al. Clinical guideline for the evaluation, management and long-term care of obstructive sleep apnea in adults. J Clin Sleep Med (3): (IV) Freedman. Treatment of obstructive sleep apnea syndrome. Clin Chest Med (2): (V) Global Initiative for Asthma (GINA). Global Strategy for Asthma Management and Prevention: Global Initiative for Asthma (GINA); (IV) Global Initiative for Chronic Obstructive Lung Disease. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease. Bethesda; (IV) 2018 Change Healthcare, LLC and/or its subsidiaries. All Rights Reserved. Produced in Cork, Ireland. 3
4 Gotzsche and Johansen. Intravenous alpha-1 antitrypsin augmentation therapy for treating patients with alpha-1 antitrypsin deficiency and lung disease. Cochrane Database Syst Rev 2010(7):CD (I) Gould et al. Evaluation of individuals with pulmonary nodules: when is it lung cancer? Diagnosis and management of lung cancer, 3rd ed: American College of Chest Physicians evidencebased clinical practice guidelines. Chest (5 Suppl):e93S-120S. (IV) Guidelines for the investigation of contacts of persons with infectious tuberculosis. Recommendations from the National Tuberculosis Controllers Association and CDC. MMWR Recomm Rep (RR-15):1-47. (IV) Han et al. The language of medically unexplained dyspnea. Chest (4): (V) Harris et al. Hypersomnias of central origin. Neurol Clin (4): (V) Hauck et al. Identification and management of latent tuberculosis infection. Am Fam Physician (10): (V) Hooper et al. Investigation of a unilateral pleural effusion in adults: British Thoracic Society Pleural Disease Guideline Thorax Suppl 2:ii4-17. (IV) Ioachimescu and Collop. Sleep-disordered breathing. Neurol Clin (4): (V) Irwin et al. Diagnosis and management of cough executive summary: ACCP evidence-based clinical practice guidelines. Chest (1 Suppl):1S-23S. (IV) Jensen et al. Guidelines for preventing the transmission of Mycobacterium tuberculosis in healthcare settings, MMWR Recomm Rep (17): (IV) Katz et al. Guidelines for the diagnosis and management of gastroesophageal reflux disease. Am J Gastroenterol (3):308-28; quiz 29. (IV) Kearon et al. Antithrombotic therapy for VTE disease: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest (2 Suppl):e419S-94S. (IV) Khan et al. Resistant hypertension and obstructive sleep apnea. Int J Hypertens : (V) Khan et al. The calcified lung nodule: What does it mean? Ann Thorac Med (2): (V) Kohnlein and Welte. Alpha-1 antitrypsin deficiency: pathogenesis, clinical presentation, diagnosis, and treatment. Am J Med (1):3-9. (V) Kuriakose and Patel. Acute pulmonary embolism. Radiol Clin North Am (1): (V) Kushida et al. Practice parameters for the treatment of snoring and Obstructive Sleep Apnea with oral appliances: an update for Sleep (2): (IV) Kushida et al. Practice parameters for the use of continuous and bilevel positive airway pressure devices to treat adult patients with sleep-related breathing disorders. Sleep (3): (IV) Laraque et al. Performance of nucleic acid amplification tests for diagnosis of tuberculosis in a large urban setting. Clin Infect Dis (1): (III) Lazarus. Clinical practice. Emergency treatment of asthma. N Engl J Med (8): (V) Light. The undiagnosed pleural effusion. Clin Chest Med (2): (V) Madison and Irwin. Cough: a worldwide problem. Otolaryngol Clin North Am (1):1-13, vii. (V) 2018 Change Healthcare, LLC and/or its subsidiaries. All Rights Reserved. Produced in Cork, Ireland. 4
5 Mandell et al. Infectious Diseases Society of America/American Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults. Clin Infect Dis Suppl 2:S Updated Jun (IV) Maskell NA, Butland RJ. BTS guidelines for the investigation of a unilateral pleural effusion in adults. Thorax 2003; 58 Suppl 2:ii8-17. (IV) Mazurek et al. Updated guidelines for using Interferon Gamma Release Assays to detect Mycobacterium tuberculosis infection - United States, MMWR Recomm Rep (RR- 5):1-25. (IV) McDaid et al. A systematic review of continuous positive airway pressure for obstructive sleep apnoea-hypopnoea syndrome. Sleep Med Rev (6): (I) Morice et al. Recommendations for the management of cough in adults. Thorax Suppl 1:i1-24. (IV) Nannini et al. Combined corticosteroid and long-acting beta-agonist in one inhaler versus placebo for chronic obstructive pulmonary disease. Cochrane Database Syst Rev 2007(4):CD (I) National Heart, Lung, and Blood Institute. Expert Panel Report 3: Guidelines for the Diagnosis and Management of Asthma - Full Report In: National Asthma Education and Prevention Program (NAEPP). Bethesda: National Institutes of Health; (IV) National Institute for Health and Care Excellence. Venous thromboembolic diseases: diagnosis, management and thrombophilia testing. Clinical guideline 144. London: National Institute for Health and Care Excellence; (IV) Pellegrino et al. Interpretative strategies for lung function tests. Eur Respir J (5): (V) Porcel and Light. Diagnostic approach to pleural effusion in adults. Am Fam Physician (7): (V) Practice guidelines for the perioperative management of patients with obstructive sleep apnea: an updated report by the American Society of Anesthesiologists Task Force on Perioperative Management of patients with obstructive sleep apnea. Anesthesiology (2): (IV) Pratter. Chronic upper airway cough syndrome secondary to rhinosinus diseases (previously referred to as postnasal drip syndrome): ACCP evidence-based clinical practice guidelines. Chest (1 Suppl):63S-71S. (IV) Qaseem et al. Diagnosis and Management of Stable Chronic Obstructive Pulmonary Disease: A Clinical Practice Guideline Update from the American College of Physicians, American College of Chest Physicians, American Thoracic Society, and European Respiratory Society. Ann Intern Med (3): (IV) Qaseem et al. Management of Obstructive Sleep Apnea in Adults: A Clinical Practice Guideline From the American College of Physicians. Ann Intern Med (IV) Qaseem et al. Risk assessment for and strategies to reduce perioperative pulmonary complications for patients undergoing noncardiothoracic surgery: a guideline from the American College of Physicians. Ann Intern Med (8): (IV) Rivera et al. Establishing the diagnosis of lung cancer: Diagnosis and management of lung cancer, 3rd ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest (5 Suppl):e142S-65S. (IV) Sawyer et al. A systematic review of CPAP adherence across age groups: clinical and empiric insights for developing CPAP adherence interventions. Sleep Med Rev (6): (I) 2018 Change Healthcare, LLC and/or its subsidiaries. All Rights Reserved. Produced in Cork, Ireland. 5
6 Smetana. Postoperative pulmonary complications: an update on risk assessment and reduction. Cleve Clin J Med Suppl 4:S60-5. (V) Stein et al. Gadolinium-enhanced magnetic resonance angiography for pulmonary embolism: a multicenter prospective study (PIOPED III). Ann Intern Med (7):434-43, W (III) Sundaram et al. Multidetector high-resolution computed tomography of the lungs: protocols and applications. J Thorac Imaging (2): (V) Tarlo. Cough: occupational and environmental considerations: ACCP evidence-based clinical practice guidelines. Chest (1 Suppl):186S-96S. (IV) Treatment of tuberculosis. MMWR Recomm Rep (RR-11):1-77. (IV) Tuberculosis Coalition for Technical Assistance (TBCTA). International Standards for Tuberculosis Care; (IV) Updated guidelines for the use of nucleic acid amplification tests in the diagnosis of tuberculosis. MMWR Morb Mortal Wkly Rep (1):7-10. (IV) Uresandi et al. National Consensus on the Diagnosis, Risk Stratification and Treatment of Patients with Pulmonary Embolism. Arch Bronconeumol (12): (V) Wechsler. Managing asthma in primary care: putting new guideline recommendations into context. Mayo Clin Proc (8): (V) Wielputz et al. Radiological diagnosis in lung disease: factoring treatment options into the choice of diagnostic modality. Dtsch Arztebl Int (11): (V) Yang et al. Inhaled corticosteroids for stable chronic obstructive pulmonary disease. Cochrane Database Syst Rev 2007(2):CD (I) Yoo et al. Anticoagulant treatment for subsegmental pulmonary embolism. Cochrane Database Syst Rev :CD (I) 2018 Change Healthcare, LLC and/or its subsidiaries. All Rights Reserved. Produced in Cork, Ireland. 6
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