Details:

Alternative Title:
Am J Clin Pathol
Publisher's site:
http://dx.doi.org/10.1093/ajcp/aqx147
Personal Author:
Rubinstein, Matthew ; Hirsch, Robert ; Bandyopadhyay, Kakali ; Madison, Bereneice ; Taylor, Thomas ; ... More +
Rubinstein, Matthew ; Hirsch, Robert ; Bandyopadhyay, Kakali ; Madison, Bereneice ; Taylor, Thomas ; Ranne, Anne ; Linville, Millie ; Donaldson, Keri ; Lacbawan, Felicitas ; Cornish, Nancy E. Less -
Description:
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.


Subject:
[+]
Clinical Decision-making
Clinical Laboratory Services
Editor's Choice
Featured
Laboratory Diagnosis
Laboratory Medicine
Laboratory Test Utilization
Meta-analysis
Quality Assurance
Quality Improvement
Review Articles
Systematic Review
Test Ordering
Utilization Management
Utilization Review

Source:
Am J Clin Pathol. 2018; 149(3):197-221.
Pubmed ID:
29471324
Pubmed Central ID:
PMC6016712
Document Type:
Journal Article
Collection(s):
CDC Public Access
Main Document Checksum:
[+]
urn:sha256:660a4b332df39333155e8da477b45e32b20ad75fdc70d2fbfa286aa4ec659660
File Type:

Supporting Files

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