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American journal of clinical pathology
Feb 17, 2018;149 (3): 197-221.

Effectiveness of Practices to Support Appropriate Laboratory Test Utilization: A Laboratory Medicine Best Practices Systematic Review and Meta-Analysis.

Matthew Rubinstein, Robert Hirsch, Kakali Bandyopadhyay, Bereneice Madison, Thomas Taylor, Anne Ranne, Millie Linville, Keri Donaldson, Felicitas Lacbawan, Nancy Cornish
Author Information
  1. Matthew Rubinstein: Centers for Disease Control and Prevention, Atlanta, GA.
  2. Robert Hirsch: Carter Consulting, Atlanta, GA.
  3. Kakali Bandyopadhyay: Deloitte Consulting, Atlanta, GA.
  4. Bereneice Madison: Centers for Disease Control and Prevention, Atlanta, GA.
  5. Thomas Taylor: Centers for Disease Control and Prevention, Atlanta, GA.
  6. Anne Ranne: Centers for Disease Control and Prevention, Atlanta, GA.
  7. Millie Linville: Deloitte Consulting, Atlanta, GA.
  8. Keri Donaldson: Pennsylvania State University, State College.
  9. Felicitas Lacbawan: Quest Diagnostics Nichols Institute, San Juan Capistrano, CA.
  10. Nancy Cornish: Centers for Disease Control and Prevention, Atlanta, GA.
PMID: 29471324 DOI: 10.1093/ajcp/aqx147

Abstract

OBJECTIVES: To evaluate the effectiveness of practices used to support appropriate clinical laboratory test utilization.
METHODS: This review followed the Centers for Disease Control and Prevention (CDC) Laboratory Medicine Best Practices A6 cycle method. Eligible studies assessed one of the following practices for effect on outcomes relating to over- or underutilization: computerized provider order entry (CPOE), clinical decision support systems/tools (CDSS/CDST), education, feedback, test review, reflex testing, laboratory test utilization (LTU) teams, and any combination of these practices. Eligible outcomes included intermediate, systems outcomes (eg, number of tests ordered/performed and cost of tests), as well as patient-related outcomes (eg, length of hospital stay, readmission rates, morbidity, and mortality).
RESULTS: Eighty-three studies met inclusion criteria. Fifty-one of these studies could be meta-analyzed. Strength of evidence ratings for each practice ranged from high to insufficient.
CONCLUSION: Practice recommendations are made for CPOE (specifically, modifications to existing CPOE), reflex testing, and combined practices. No recommendation for or against could be made for CDSS/CDST, education, feedback, test review, and LTU. Findings from this review serve to inform guidance for future studies.

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MeSH Term

Clinical Laboratory Techniques
Decision Support Systems, Clinical
Humans
Medical Order Entry Systems
Practice Guidelines as Topic
Quality Assurance, Health Care
Quality Improvement
Journal Article Meta-Analysis Review Systematic Review
Article has an altmetric score of 32

Word Cloud

Created with Highcharts 10.0.0practicestestreviewstudiesoutcomesLaboratoryPracticesCPOEsupportclinicallaboratoryutilizationMedicineBestEligibleCDSS/CDSTeducationfeedbackreflextestingLTUegtestsmadeOBJECTIVES:evaluateeffectivenessusedappropriateMETHODS:followedCentersDiseaseControlPreventionCDCA6cyclemethodassessedonefollowingeffectrelatingover-underutilization:computerizedproviderorderentrydecisionsystems/toolsteamscombinationincludedintermediatesystemsnumberordered/performedcostwellpatient-relatedlengthhospitalstayreadmissionratesmorbiditymortalityRESULTS:Eighty-threemetinclusioncriteriaFifty-onemeta-analyzedStrengthevidenceratingspracticerangedhighinsufficientCONCLUSION:PracticerecommendationsspecificallymodificationsexistingcombinedrecommendationFindingsserveinformguidancefutureEffectivenessSupportAppropriateTestUtilization:SystematicReviewMeta-Analysis

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