VALIDITY OF UTILIZATION MANAGEMENT CRITERIA FOR PSYCHIATRY

Objective: This study examined the validity of four psychiatric utiliz ation management criteria sets: the 1992 and 1993 InterQual Intensity, Severity, and Discharge (ISD) criteria, the Managed Care Appropriaten ess Protocol, and an instrument developed by the Department of Veteran s Affairs (VA). Method: The appropriateness of acute care admission an d continued stay for 70 randomly selected VA psychiatric inpatients wa s retrospectively assessed with each criteria set. The sensitivity and specificity of each instrument were evaluated by comparing its assess ments to the consensus of judgments of a panel of expert psychiatrists who reviewed the same cases. Sensitivity was defined as the proportio n of admissions or continued-stay days the panel found appropriate for acute care that the criteria judged to be appropriate for acute care; specificity was the proportion the panel found inappropriate for acut e cave that the criteria judged to be inappropriate for acute care. Re sults: For admissions, there were only minor differences in the validi ty oi the four criteria sets as assessed by agreement with the panel's judgments. For each of 4 continued-stay days studied, either the sens itivity or specificity of the 1993 InterQual ISD criteria was below 0. 30. The specificity of the 1992 InterQual ISD criteria was below 0.60 for 2 days. In contrast, for the Managed Care Appropriateness Protocol , sensitivity was 0.73-0.93 and specificity was 0.78-0.88 over the 4 d ays. Conclusions: The findings mise major concerns about the validity of the widely used InterQual ISD psychiatry criteria, suggest that the Managed Care Appropriateness Protocol may be a useful tool for psychi atric utilization management, strongly underline the need to validate all criteria used to assess medical care, and support the appropriaten ess of the procedures used to perform these assessments.