Standard HMO criteria for psychiatric admissions and discharge may be Inadequate

Psychiatric criteria used by health maintenance organizations (HMOs) to determine hospital admittance and discharge may be inadequate, according to a recent study published in the American Journal of Psychiatry. HMOs currently use the InterQual Intensity, Severity and Discharge criteria (InterQual ISD) to make decisions about hospitalization of psychiatric patients. However, researchers at the Veterans Affairs (VA) Office of Policy, Planning and Performance in Washington D.C. say that their "findings raise major concerns about the validity of the InterQual ISD". Their research shows that following the criteria set forth by the InterQual ISD "may lead to acutely ill patients having their hospitalizations inappropriately abbreviated." In other words, mental health patients may be discharged from the hospital too early and may not receive the complete care that they need.

A panel of seven VA psychiatrists and one VA intern, all who have "special expertise in making judgments regarding the need for acute care", were involved in the study. The panelists evaluated 70 patient cases and then the results were compared to InterQual ISD scores for the same patients. While the panelists' judgments and InterQual ISD hospital admission criteria agreed, the InterQual ISD hospital discharge criteria significantly differed from the panelists judgments. In evaluating the criteria for discharge, "both false positive and false negative errors occurred frequently", according to the researchers. Other facets of the 1993 InterQual ISD criteria were studied, and results further dispute the validity of the criteria.

The researchers found that results of the Managed Care Appropriateness Protocol better agreed with the panelists evaluations. This was true for both the admissions and discharge criteria. However, the authors say that the Managed Care Appropriateness Protocol is seldom used among HMOs, while the InterQual ISD "used in the great bulk of utilization review". In regards to the InterQual ISD, the authors remind us that "wide acceptance of an instrument is clearly not sufficient to justify its use".

According to the VA researchers, "continued use of these criteria appears questionable until they are modified" Furthermore, "the Managed Care Appropriateness Protocol performed more adequately and may be a useful tool."

SOURCE: American Journal of Psychiatry (1997;154(3):349-354)

Web page of Am. Jrnl of Psych. (abstracts available)

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