Protocols

Find standardized, evidence-based protocols for use in your practice. When embedded in electronic health records, treatment protocols can serve as clinical decision support at the point of care so no opportunities are missed to achieve control.

Cholesterol Management Protocols

High low-density lipoprotein (LDL) cholesterol is a major risk factor for heart attack, stroke, and atherosclerotic cardiovascular disease (ASCVD). The use of evidence-based protocols is one strategy to manage and lower cholesterol levels among patients with established ASCVD and patients at risk for heart attack, stroke, or ASCVD.

Create Your Own Protocol

In 2013, the American College of Cardiology (ACC) and the American Heart Association (AHA) released new clinical guidelines on the treatment of blood cholesterol to reduce ASCVD risk in adults. You can create your own cholesterol management protocol using the flow diagram from the guidelines. Or you can adapt one of the featured evidence-based protocols below.

The guidelines from the ACC and AHA recommend statin use among four major statin benefit groups:

  • Individuals with clinical ASCVD
  • Individuals with primary elevations of LDL-C ≥190 mg/dL
  • Individuals aged 40 to 75 who have diabetes with LDL-C of 70 to 189 mg/dL and without clinical ASCVD
  • Individuals without clinical ASCVD or diabetes with LDL-C of 70 to 189 mg/dL and estimated 10-year ASCVD risk ≥7.5%

Companion Provider Tool

The ASCVD Risk Estimator calculates the estimated 10-year and lifetime ASCVD risk among patients without ASCVD. By entering basic demographic characteristics and medical information, you can use the calculator to determine your patient’s estimated risk for ASCVD. The ASCVD risk estimates can also be used to facilitate a discussion between you and your patients about how to reduce risk for ASCVD.

Featured Evidence-Based Protocols*

Veterans Administration

Veterans Affairs (VA)/ Department of Defense (DoD)

This algorithm for management of dyslipidemia addresses treatment and management strategies for managing overall cardiovascular disease risk among patients with dyslipidemia. It is designed to assist primary care providers in managing lipids among patients at risk for cardiovascular disease.

Kaiser Permanente

Kaiser Permanente

The Kaiser Permanente National Dyslipidemia Management Clinician Guide was developed to assist primary care physicians and other clinicians in the outpatient management of cholesterol for primary and secondary prevention of ASCVD.

Institute for Clinical Systems Improvement

Institute for Clinical Systems Improvement

The Lipid Management in Adults algorithm describes the treatment of adults age 20 and older who are dyslipidemic. Clinical highlights of this protocol include initiating a statin with patients who have established ASCVD, establishing lipid goals based on risk level, instructing patients on healthy lifestyle and adjunctive measures, and reinforcing patient adherence with recommended therapy during scheduled follow-up.


Tobacco Cessation Protocols

No level of smoking or tobacco use is safe. Tobacco addiction is a chronic condition, often requiring multiple quit attempts for a tobacco user to become tobacco free. There are effective, evidence-based, brief clinical interventions available to help patients who smoke. Tobacco cessation protocols can be integrated into the tobacco use identification and intervention clinical workflow.

Create Your Own Protocol

Create your own tobacco cessation protocol using our template and implementation guidance document, which includes insights from stakeholders in the tobacco cessation community.

Featured Evidence-Based Protocols*

Harvard Vanguard Medical Associates

Atrius Health and Harvard Vanguard Medical Associates Tobacco Intervention Workflow

This tobacco intervention workflow is included in a question-and-answer style case study that highlights an extensive health systems change effort that was undertaken by Atrius Health and Harvard Vanguard Medical Associates to improve tobacco dependence treatment in a health care system.

Louisiana State University

Louisiana State University Health System Tobacco Control Initiative Treatment Protocol

This treatment protocol is included in a question-and-answer style case study that provides an overview of Louisiana State University Health System Tobacco Control Initiative, which is focused on developing and implementing a systematic approach to treating tobacco use in one of the largest safety-net health delivery systems in the country.

VA Logo

Veterans Health Administration (VHA): Tobacco Use Cessation Treatment Guidance

This three-part treatment guidance includes two easy-to-use charts and a table detailing VHA medication options. Part 1 provides guidance on “The 5 A’s” (ask, advise, assess, assist, arrange) used to address tobacco use among current and former smokers. Part 2 provides a flowchart to assist providers in selecting VHA first-line therapies and what to do for those patients who relapse. Part 3 consists of a detailed table describing VHA smoking cessation medication regimens, including pros/cons, limitations, and dosing recommendations.

Tools and Resources

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Hypertension Treatment Protocols

Use standardized treatment protocols to improve blood pressure control by clarifying titration intervals revealing new treatment options and expanding the types of staff that can assist in timely follow-up with patients.

Create Your Own Protocol

Create your own hypertension treatment protocol using our template, guidance document, interactive guide and insights from established stakeholder in the heart disease and stroke prevention and treatment community.

Featured Evidence-Based Protocols*

Veterans Affairs Logo

Veterans Affairs (VA)/Department of Defense (DoD)

The VA/DoD protocol focuses on the critical decision points in the management of hypertension in primary care.

Protocol

  • Use of thiazide diuretics as first-line therapy
  • Recommendations for prehypertension and treatment by stage of hypertension
  • Target goals vary depending on patient’s co-morbidities (e.g., diabetes, chronic kidney disease)
  • The evidence base for each step
  • Recommended lab tests

Supplemental Guidance

  • Recommendations for specific segments of patient populations
  • Impact of lifestyle therapies on blood pressure in hypertensive adults
  • Causes of inadequate response to therapy
  • Strategies to improve patient adherence
Kaiser Permanente Logo

Kaiser Permanente

The Kaiser Permanente protocol was developed for use by integrated health care delivery systems that care for adults.

Protocol

  • Use of thiazide diuretic/ACE inhibitor combinations as first-line therapy; when feasible, single pill combination tablets are preferred
  • Guidelines for women of child-bearing potential
  • Recommended drugs and dosages
  • Documentation of the number needed to treat to prevent one additional negative health outcome

Supplemental Guidance

  • Systems-based approach that establishes a comprehensive hypertension control program with these elements:
    • Treatment protocol elements listed previously
    • Team-based care
    • Convenient blood pressure checks
    • Population registry
    • Quality performance goals
    • Quality performance tracking metrics
  • Self-monitoring blood pressure
ICSI Logo

Institute for Clinical Systems Improvement (ICSI)

The ICSI protocol was developed for use by networks of medical groups.

Protocol

  • Hyperlinks to more information on various topics
  • Classification of blood pressure includes ambulatory home/24hr monitor

Supplemental Guidance

  • Treatment of subpopulations (e.g., racial/ethnical minorities, patients with resistant hypertension)
  • Quality improvement
  • Extensive supporting references

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*About Featured Protocols

The featured protocols are examples of a wide variety of available evidence-based protocols that practices and health care systems may consider for adoption and use. Linking to non-federal sites does not constitute an endorsement by the Department of Health and Human Services, the Centers for Disease Control and Prevention, or any of their employees of the sponsors or the information or products presented on the sites. Links to non-federal sites containing protocols serve only as a source of guidance. Health care professionals should always consider the individual clinical circumstances of each person. Links to the protocols are not intended to be a substitute for professional medical advice; individuals should seek advice from their health care professionals.

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