InterQual® Evidence-Based Development

InterQual® Criteria are produced using a rigorous development process based on the principles of evidence-based medicine (EBM) to give you complete confidence in the underlying guidance the criteria provide.

Unmatched Clinical Integrity

InterQual® Criteria are produced using a rigorous development process based on the principles of evidence-based medicine (EBM) to give you complete confidence in the underlying guidance the criteria provide. Our content development and updating approach involves a five-step process:

1. Identify content for development and updating

  • Teams of physicians, registered nurses and allied health professionals monitor the latest evidence, national guidance, industry/regulatory trends, and client needs to identify, assess, and case-test potential new offerings and changes to existing content.
  • A proprietary, automated literature surveillance system monitors more than 3,000 guidelines, guideline issuers, and medical societies for newly published medical literature.
  • Criteria updates are provided at least once annually but as frequently as quarterly as new evidence warrants.

2. Teams identify and critically appraise clinical evidence

  • Development teams formulate key questions and search bibliographic databases (e.g., PubMed) and other key sources (e.g., specialty societies).
  • Study validity is evaluated using extensive training by the Delfini Group.
  • Sources are classified and cited; landmark studies are acknowledged when applicable.
  • Findings from multiple primary studies are combined using elements of the GRADE approach so that the overall quality of evidence is apparent for each clinically relevant outcome.

3. Physician-led groups develop new and updated content

  • New or updated evidence-based content drafts are created in an iterative process led by physicians.
  • Recommendations intended to optimize clinical outcomes while minimizing invasive, costly, or potentially harmful interventions are included.
  • Detailed notes and literature references are provided to show the clinical basis for decisions.

4. Independent clinical review panel drawn from more than 1,000 experts provides authoritative peer review

  • All clinical review panel members are board-certified physicians or appropriately registered non-physicians, in active practice, and screened for conflicts of interest.
  • Multiple reviewers evaluate each proposed criteria point for correct interpretation of the literature.
  • For situations that do not lend themselves to accepted research methods, larger and more geographically dispersed groups of clinical experts are used to establish best practices which reflect the current standard of care.

5. Clinical team conducts final quality assurance check and releases content

  • A clinical team reviews content for completeness and clinical consistency across products as well as medical coding.
  • InterQual’s medical director provides oversight throughout the development process to help ensure clinical accuracy.
  • Extensive clinical revision summaries accompany each release to explain changes and rationales.

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