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

Overview

Journal Am J Clin Pathol

Publisher Oxford University Press

Specialty Pathology

Date 2018 Feb 23

PMID 29471324

Citations 24

Authors

Matthew Rubinstein

Robert Hirsch

Kakali Bandyopadhyay

Bereneice Madison

Thomas Taylor

Anne Ranne

Millie Linville

Keri Donaldson

Felicitas Lacbawan

Nancy Cornish

Affiliations

Soon will be listed here.

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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