TY - JOUR
T1 - Effectiveness of Practices to Support Appropriate Laboratory Test Utilization
AU - Rubinstein, Matthew
AU - Hirsch, Robert
AU - Bandyopadhyay, Kakali
AU - Madison, Bereneice
AU - Taylor, Thomas
AU - Ranne, Anne
AU - Linville, Millie
AU - Donaldson, Keri
AU - Lacbawan, Felicitas
AU - Cornish, Nancy
N1 - Funding Information:
Corresponding author: Matthew Rubinstein, MS, Centers for Disease Control and Prevention, MS-G23, 1600 Clifton Rd, Atlanta, GA 30333; [email protected]. Funding source: Work conducted by Kakali Bandyopadhyay and Millie Linville was supported by CDC funding for the Laboratory Medicine Best Practices Initiative to Westat-Deloitte under contract (HHSD2002013M53968B/2002013F57569). Work conducted by Robert Hirsch was supported under contract to Carter Consulting (200-2010-37203). Acknowledgments: We thank Jacqueline Goolsby (DLS, CDC), Elizabeth Leibach (DLS, CDC), Paramjit Sandhu (DLS, CDC), Sonya Strider (DLS, CDC), Joanna Taliano (CDC Library), the LMBP Workgroup, and the LMBP test utilization expert panel. Disclaimer: The findings and conclusions in this article are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.
Publisher Copyright:
© American Society for Clinical Pathology, 2018.
PY - 2018/2/17
Y1 - 2018/2/17
N2 - 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.
AB - 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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U2 - 10.1093/ajcp/aqx147
DO - 10.1093/ajcp/aqx147
M3 - Review article
C2 - 29471324
AN - SCOPUS:85042530707
SN - 0002-9173
VL - 149
SP - 197
EP - 221
JO - American journal of clinical pathology
JF - American journal of clinical pathology
IS - 3
ER -