What are the advantages of using the Care Guidelines rather than traditional symptom-based criteria?

Milliman Care Guidelines uses a diagnosis-based approach; Care Guidelines products are organized by diagnoses or diagnostic groups such as community-acquired pneumonia or substance abuse disorders. Another approach is traditional symptom-based criteria, organized by manifestations of illness such as symptoms, behaviors, or functional deficits. Advantages of a diagnosis-based approach include:

• It outlines disease-specific best practices such as timing of antibiotic therapy for community-acquired pneumonia or surgical procedures.
• It provides disease-specific length of stay benchmarks (Goal Length of Stay).
• It provides greater depth of content employing a larger evidence base.
• It is useful in managing recovery delays.
• It promotes consistent, proactive care management, not simply a snapshot.
• It stimulates questions:
• “Is plan of care in place?”
• “Is the patient making progress toward the goal?”
• “What additional services does the patient require?”
• Not simply “Does the patient meet criteria?”
• Users require greater sophistication because of greater depth of content and longitudinal approach to care.