[NRSKarenRN]

Interqual is proprietary program...need to pay for access to site/book.


The Birth of InterQual: Evidence-Based Decision Support Criteria That Helped Change Healthcare
A. Jacqueline Mitus MD

Professional Case Management
July/August 2008
Volume 13 Number 4
Pages 228 - 233

ABSTRACT


Purpose/objectives: InterQual evidence-based clinical decision support criteria are used by thousands of organizations in healthcare. What industry trends led to their creation, and what accounts for their longevity and widespread acceptance?

Primary practice settings(s): Hospitals, health systems, and managed care organizations.

Findings/conclusions: Although the healthcare puzzle sometimes seems too complicated for anyone to solve, passionate people with good ideas have been able to effect substantive and relatively rapid change throughout healthcare history.

Implications for case management practice:

1. Prior to the general use of consistent and rigorous utilization management, widespread care variations, excessive healthcare costs, and less-than-optimal care were the rule rather than the exception.

2. Strategically and methodically overcoming resistance to change—starting small and the expanding outward—is the key component in reinventing healthcare.

3. In the end, if a process does not make sense, it needs to change. Take on that responsibility, joining with like-minded individuals to build momentum.

[snotpikkr]

IQ is not very patient friendly, that's for sure, and that's what we use at our hospital, however when a patient doesn't meet the criteria, our physician advisor overrides the criteria. Everyone including Medicare knows that the criteria is not always appropriate. It gives McKesson a good laugh every day, though. They also run Comedy Central!
It's an expensive program we're all subjected to.