Most health care facilities use this type of screening criteria for utilization review purposes to determine the need for inpatient services and justification for continued stay.

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Severity of illness/intensity of service criteria (SI/IS) is the most commonly used screening criteria for utilization review purposes to determine the need for inpatient services and justification for continued stay. SI/IS criteria assess the severity of the patient's illness and the intensity of services required to manage it. This helps to ensure that patients are receiving appropriate levels of care in the most appropriate setting. Critical pathways and Joint Commission defined and developed criteria are also used in utilization review but are more focused on ensuring that patients receive care in accordance with evidence-based guidelines and best practices. HEDIS measures are used to evaluate health plan performance and measure quality of care, but are not typically used in the same way for utilization review purposes.

Most Health Care Facilities Use This Type of Screening Criteria