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Meta-Analysis
. 2018 Feb 17;149(3):197-221.
doi: 10.1093/ajcp/aqx147.

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

Matthew Rubinstein  1 , Robert Hirsch  2 , Kakali Bandyopadhyay  3 , Bereneice Madison  1 , Thomas Taylor  1 , Anne Ranne  1 , Millie Linville  3 , Keri Donaldson  4 , Felicitas Lacbawan  5 , Nancy Cornish  1
Affiliations
Meta-Analysis

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

Matthew Rubinstein et al. Am J Clin Pathol. .

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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Figures

Figure 1
Figure 1
Analytic framework. CPOE, computerized provider order entry.
Figure 2
Figure 2
Study selection flow diagram. CDSS, clinical decision support system; CPOE, computerized provider order entry; LTU, laboratory test utilization.
Figure 3
Figure 3
Forest plot for computerized provider order entry modification studies. CI, confidence interval.
Figure 4
Figure 4
Forest plot for clinical decision support systems/tools studies. CI, confidence interval.
Figure 5
Figure 5
Forest plot for education studies. CI, confidence interval.
Figure 6
Figure 6
Forest plot for feedback studies. CI, confidence interval.
Figure 7
Figure 7
Forest plot for reflex testing studies. CI, confidence interval.
Figure 8
Figure 8
Forest plot for test review studies. CI, confidence interval.
Figure 9
Figure 9
Forest plot for combined practice studies. CI, confidence interval.
Figure 10
Figure 10
Pie chart for facility setting across all included studies. VA, Veterans Affairs.
Figure 11
Figure 11
Pie chart for practice category across all included studies. CDSS, clinical decision support systems; CPOE, computerized provider order entry.
See this image and copyright information in PMC

References

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