What is the authority of the Care Guidelines? How are they derived?

The Care Guidelines are founded on the use of evidence-based research methodology to support the development and understanding of medical care processes. Milliman Care Guidelines takes its definition of evidence-based medicine from David Sackett’s article, "Evidence-Based Medicine: What It Is and What It Isn't," which appeared in the British Medical Journal in January, 1996: "Evidence-based medicine is the conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients."

Sources of information for all Care Guidelines include medical literature and textbooks, nationally recognized guidelines published in all fields of medicine, practice observations and database analyses. In weighing and grading the evidence, Milliman Care Guidelines uses the following generally accepted hierarchy of evidence (in condensed form), with the first level being the most important:

• Evidence Grade 1: Randomized controlled trials
• Evidence Grade 2: Other published sources
• Evidence Grade 3: Unpublished research, large databases, quality improvement projects, expert practitioner reports