We Follow the Science—and Defend Against Bias

By Laura Coughlin, RN, BSN, MBA
VP, Clinical Innovation and Development, Change Healthcare

As the pandemic gained momentum in mid-2020, many Americans were comforted by the frequent invocation from Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases: “Follow the science.” The phrase became a mantra of sorts, with its own proponents and detractors. The emergence of this catch phrase was interesting to me, as I’ve dedicated the last 22 years of my professional career to developing unbiased, objective, evidence-based criteria. ‘Follow the science’ isn’t a catch phrase for the InterQual^® team. 

For us, following the science is much more than simply finding and digesting studies published in peer-reviewed journals. Our rigorous content development process includes a thorough evaluation of the quality of published evidence coupled with a defense against bias in two key steps: critical appraisal and peer review.

The Initial Critical Appraisal

First, our physician-led teams—comprised of 50 clinicians trained in critical appraisal methods—focus on assessing the validity of the articles. One study looked through 20 years of systematic reviews to determine that up to a third of article abstracts contain information that is inconsistent with the full report, or that is different enough to change the study conclusion.¹

The InterQual clinician team is deeply committed to ensuring the highest levels of scrutiny are applied to the published evidence throughout the critical appraisal validation processes. The team is always raising the bar on our evidentiary processes to help ensure that we are providing the most current, valid evidence to the market. 

One recent example of our commitment to content development innovation is the creation of a proprietary web-based analytics tool programmed to monitor more than 3,000 sites. As it can take six to eight weeks for published content to make its way onto the PubMed platform, this tool helps alert our teams to the publication of relevant releases right away. We work diligently to provide updated evidence-based content to our customers as soon as possible, which can be as frequent as every six to eight weeks. 

The Clinical Peer Review Panel 

The distinguishing factor of our content development process is the next step: the InterQual clinical peer review panel, which comprises nearly 1,100 actively practicing clinicians across the country. Two-thirds of these reviewers are physicians, while the remainder are other healthcare clinicians such as psychologists, pharmacists, advance practice nurses, and therapists. These peer reviewers are screened for conflicts of interest and are credentialed by Change Healthcare every two years.

The clinical peer review panel conducts a thorough peer review validation of our content. Board-certified specialists review and validate the critical appraisal of the content that falls within their area of specialty. They also notify us of soon-to-be-released society guidelines and articles pertinent to the content in question, and help to translate standards of care into evidence-based practice guidelines. 

Future Process Innovations 

As Change Healthcare has grown, so has our InterQual team.  I’ve been privileged to lead a group of clinicians with an average tenure of 14+ years. As we’ve added new physician leaders, each and every one has commented on the clinical rigor of our evidence-based processes. They have specifically noted that our processes surpass those of other organizations they’ve worked with throughout their careers, a revelation which is gratifying, albeit unsurprising. 

As our team is a part of Change Healthcare, we have access to a wealth of data and technologists. Aggregated data and AI-enabled technologies are instrumental to the future of content curation. Our data can help us understand current practices and develop benchmarking that provides yet another element of decision support to help clinicians make the best possible choices.  

Our cloud-based solutions provide insights into how the InterQual content is being utilized by our customers, which helps us focus our development efforts on highly utilized services and conditions. AI is also helping our team add a personalized, patient-specific layer of decision support to the InterQual portfolio, which will help clinicians predict a patient’s level of care, length of stay, and discharge destination. The combination of predictive analytics and evidence-based InterQual content will help fuel continual improvements in decision-making to impact patient outcomes in the future.

Since 1976, the InterQual brand has been synonymous with the best in evidence-based clinical decision support. Our content is trusted world-wide, from Australia to the Middle East, Europe, and North America. Our commitment to the development of objective, evidence-based content is unwavering, regardless of what changes the future may bring.

The InterQual name originated in the idea of quality care within. Quality care is driven by evidence, but that evidence must always be validated and peer reviewed. As the world gets vaccinated and we emerge from this pandemic, the InterQual team will continue to follow the science where it leads, validating the research we find to uphold the unmatched clinical integrity of the InterQual content.   

¹ Guowei Li, et al. “A Scoping Review of Comparisons Between Abstracts and Full Reports in Primary Biomedical Research,” BMC Medical Research Methodology, December 29, 2017. https://doi.org/10.1186/s12874-017-0459-5