Change Healthcare Clinical Evidence Classification
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1 InterQual Level of Care Criteria: Home Care 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. Class II 2018 Change Healthcare, LLC and/or its subsidiaries. All Rights Reserved. Produced in Cork, Ireland. 1
2 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 ACOG Practice Bulletin. Diagnosis and management of preeclampsia and eclampsia. Number 33, January Obstet Gynecol 2002; 99(1): Reaffirmed, 2008 (IV) American Academy of Hospice and Palliative Medicine. Palliative care. [cited Dec ]. Available from: (V) American College of Obstetricians and Gynecologists (ACOG). ACOG Practice Bulletin No. 80: premature rupture of membranes. Clinical management guidelines for obstetriciangynecologists. Obstet Gynecol (4): (IV) American College of Obstetricians and Gynecologists (ACOG). Committee opinion no. 453: Screening for depression during and after pregnancy. Obstet Gynecol (2 Pt 1): (IV) American College of Obstetricians and Gynecologists (ACOG). Committee Opinion Number 294, May At-risk drinking and illicit drug use: ethical issues in obstetric and gynecologic practice. Obstet Gynecol (5 Pt 1): (IV) American College of Obstetrics and Gynecology (ACOG). Practice Bulletin: nausea and vomiting of pregnancy. Obstet Gynecol 2004, Reaffirmed (4): Reaffirmed (IV) American Psychiatric Association. Diagnostic and statistical manual of mental disorders, fifth edition. Arlington, VA: American Psychiatric Association; (IV) Armstrong et al. Comparative effectiveness of mechanically and electrically powered negative pressure wound therapy devices: a multicenter randomized controlled trial. Wound Repair Regen (3): (I CER) ASHA. Speech-Language Pathology Medical Review Guidelines. American Speech-Language- Hearing Association; Available from: [cited Nov ]. (IV) Bailit. Hyperemesis gravidarium: Epidemiologic findings from a large cohort. Am J Obstet Gynecol (3 Pt 1): (III) Barbour. ACOG practice bulletin. Thrombembolism in pregnancy. Int J Gynaecol Obstet (2): Reaffirmed (IV) Barton and Sibai. Prediction and prevention of recurrent preeclampsia. Obstet Gynecol (2): (V) Bates et al. VTE, thrombophilia, antithrombotic therapy, and pregnancy: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest (2 Suppl):e691S-736S. (IV) Bevilacqua. Current Concepts in Treating Osteomyelitis. Podiatry Today (7): (V) Bonilla et al. Practice parameter for the diagnosis and management of primary immunodeficiency. Ann Allergy Asthma Immunol (5 Suppl 1):S1-63. (IV) Brady et al. Speech and language therapy for aphasia following stroke. Cochrane Database Syst Rev :CD (I CER) Brayman et al. Scope of practice (2004). Am J Occup Ther (6): (V) 2018 Change Healthcare, LLC and/or its subsidiaries. All Rights Reserved. Produced in Cork, Ireland. 3
4 Brayman et al. Standards of practice for occupational therapy. Am J Occup Ther (6): (IV) Bryant and Nix. Acute & chronic wounds: current management concepts, 3rd edn. St. Louis, Mo.: Mosby Elsevier; (V) Centers for Medicare & Medicaid Services. Chapter 7 - Home Health Services. In: Medicare Benefit Policy Manual. Bethesda, MD: Centers for Medicare & Medicaid Services; (V) Centers for Medicare & Medicaid Services (CMS). Home health agency manual, section 204.1A. Centers for Medicare & Medicaid Services, U.S. Department of Health and Human Services; 2014 [cited Nov ]. Available from: Guidance/Guidance/Manuals/Downloads/bp102c07.pdf. Centers for Medicare and Medicaid Services. Medicare Benefit Policy Manual Chapter 1 - Inpatient Hospital Services Covered Under Part A. Centers for Medicare and Medicaid Services; June Available from: Guidance/Guidance/Manuals/Downloads/bp102c01.pdf [cited Nov ] (V) Clark. As viewed from above: connectivity and diversity in fulfilling occupational therapy's Centennial Vision. Am J Occup Ther (6): (V) Dresang et al. Venous thromboembolism during pregnancy. Am Fam Physician (12): (V) Ferkol et al. Cystic fibrosis pulmonary exacerbations. J Pediatr (2): (IV) Fernandes et al. Duration of intravenous antibiotic therapy in people with cystic fibrosis. Cochrane Database Syst Rev 2008(2):CD (I) Field MJ, Berman RE, eds., When children die: improving palliative and end-of-life care for children and their families. Washington: Natl Academy Pr: 2003, xx, 690 p. (V) Funnell et al. National standards for diabetes self-management education. Diabetes Care Suppl 1:S (IV) Hassell. Pregnancy and sickle cell disease. Hematol Oncol Clin North Am (5): , viiviii. (V) Herd et al. Speech and language therapy versus placebo or no intervention for speech problems in Parkinson's disease. Cochrane Database Syst Rev :CD (I CER) Hospice Foundation of America. Hospice care [cited Dec ]. Available from: (V) Iams et al. Frequency of uterine contractions and the risk of spontaneous preterm delivery. N Engl J Med (4): (II) Jessup et al focused update: ACCF/AHA Guidelines for the Diagnosis and Management of Heart Failure in Adults: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines: developed in collaboration with the International Society for Heart and Lung Transplantation. Circulation (14): (IV) Kaplan et al. Guidelines for prevention and treatment of opportunistic infections in HIV-infected adults and adolescents: recommendations from CDC, the National Institutes of Health, and the HIV Medicine Association of the Infectious Diseases Society of America. MMWR Recomm Rep (RR-4):1-207; quiz CE (IV) Kelechi and Johnson. Guideline for the management of wounds in patients with lower-extremity venous disease: an executive summary. J Wound Ostomy Continence Nurs (6): (III) 2018 Change Healthcare, LLC and/or its subsidiaries. All Rights Reserved. Produced in Cork, Ireland. 4
5 Leeman and Fontaine. Hypertensive disorders of pregnancy. Am Fam Physician (1): (V) Leland et al. Occupational therapy in fall prevention: current evidence and future directions. Am J Occup Ther (2): (V) Lipsky et al. Diagnosis and treatment of diabetic foot infections. Clin Infect Dis (7): (IV) Msall et al. The Functional Independence Measure for Children (WeeFIM). Conceptual basis and pilot use in children with developmental disabilities. Clin Pediatr (Phila) (7): (V) Msall et al. WeeFIM. Normative sample of an instrument for tracking functional independence in children. Clin Pediatr (Phila) (7): (III) Munro. Hematologic complications of critical illness: anemia, neutropenia, thrombocytopenia, and more. AACN Adv Crit Care (2): (V) Muzik et al. When depression complicates childbearing: guidelines for screening and treatment during antenatal and postpartum obstetric care. Obstet Gynecol Clin North Am (4): , ix-x. (IV) Myers. American Association for Respiratory Care (AARC) Clinical Practice Guideline: selection of an oxygen delivery device for neonatal and pediatric patients revision & update. Respir Care (6): (IV) National Institutes of Health Consensus Development Conference Statement. Antenatal corticosteroids revisited: repeat courses. August 17-18, Obstet Gynecol (1): National Pressure Ulcer Advisory Panel. NPUAP Pressure Injury Stages. Washington, DC: Available from: [cited Sept ]. (IV) Neilson. Interventions for treating placental abruption. Cochrane Database Syst Rev 2003(1):CD (V) NICE. Dementia: A NICE-SCIE Guideline on supporting People with Dementia and Their Carers in Health and Social Care (IV) Oppenheimer. Diagnosis and management of placenta previa. J Obstet Gynaecol Can (3): (IV) Ottenbacher et al. The reliability of the functional independence measure: a quantitative review. Arch Phys Med Rehabil (12): (I) Qaseem et al. Diagnosis and management of stable chronic obstructive pulmonary disease: a clinical practice guideline from the American College of Physicians. Ann Intern Med (9): (IV) Ratliff and Tomaselli. WOCN update on evidence-based guideline for pressure ulcers. J Wound Ostomy Continence Nurs (5): (IV) Ries et al. Pulmonary Rehabilitation: Joint ACCP/AACVPR Evidence-Based Clinical Practice Guidelines. Chest (5 Suppl):4S-42S. (IV) Sacrey et al. Reaching and grasping in autism spectrum disorder: a review of recent literature. Front Neurol :6. (V) Sayres. Preterm labor. Am Fam Physician (4): (V) Smith et al. Memory and communication support in dementia: research-based strategies for caregivers. Int Psychogeriatr (2): (V) 2018 Change Healthcare, LLC and/or its subsidiaries. All Rights Reserved. Produced in Cork, Ireland. 5
6 Soo Hoo. Noninvasive ventilation in adults with acute respiratory distress: a primer for the clinician. Hosp Pract (Minneap) (1): (V) Spruit et al. An official American Thoracic Society/European Respiratory Society statement: key concepts and advances in pulmonary rehabilitation. Am J Respir Crit Care Med (8):e (IV) Standards of medical care in diabetes Diabetes Care Suppl 1:S (IV) Toledano and Bartleson. Cervical spondylotic myelopathy. Neurol Clin (1): (V) Turnbull and Osborn. Home visits during pregnancy and after birth for women with an alcohol or drug problem. Cochrane Database Syst Rev :CD (I) Ubbink et al. A systematic review of topical negative pressure therapy for acute and chronic wounds. Br J Surg (6): (I) Walker. NICE guidance on diabetes in pregnancy: management of diabetes and its complications from preconception to the postnatal period. NICE clinical guideline 63. London, March Diabet Med (9): (IV) World Health Organization (WHO). Congenital anomalies Available from: [cited Nov ]. (V) Xie et al. The clinical effectiveness of negative pressure wound therapy: a systematic review. J Wound Care (11): (I) 2018 Change Healthcare, LLC and/or its subsidiaries. All Rights Reserved. Produced in Cork, Ireland. 6
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