|Ann Lab Med. 2018 Sep;38(5):402-412. English.|
Published online May 23, 2018. https://doi.org/10.3343/alm.2018.38.5.402
|© The Korean Society for Laboratory Medicine|
Over the past decades, Western countries have witnessed a marked rise in healthcare expenditure, with annual growth rates exceeding the rise in gross domestic product . The constantly expanding field of diagnostics has contributed to this exponential growth in curative health-care costs. Rapid increases have been seen in the volumes and costs of different types of diagnostics, with absolute test volumes doubling every five to ten years in the United States, the United Kingdom, and Canada .
Studies addressing the appropriateness of laboratory testing have revealed approximately 20% overutilization. We conducted a narrative review to (1) describe current interventions aimed at reducing unnecessary laboratory testing, specifically in hospital settings, and (2) provide estimates of their efficacy in reducing test order volume and improving patient-related clinical outcomes.
The PubMed, Embase, Scopus, Web of Science, and Canadian Agency for Drugs and Technologies in Health-Health Technology Assessment databases were searched for studies describing the effects of interventions aimed at reducing unnecessary laboratory tests. Data on test order volume and clinical outcomes were extracted by one reviewer, while uncertainties were discussed with two other reviewers. Because of the heterogeneity of interventions and outcomes, no meta-analysis was performed.
Eighty-four studies were included. Interventions were categorized into educational, (computerized) provider order entry [(C)POE], audit and feedback, or other interventions. Nearly all studies reported a reduction in test order volume. Only 15 assessed sustainability up to two years. Patient-related clinical outcomes were reported in 45 studies, two of which found negative effects.
Interventions from all categories have the potential to reduce unnecessary laboratory testing, although long-term sustainability is questionable. Owing to the heterogeneity of the interventions studied, it is difficult to conclude which approach was most successful, and for which tests. Most studies had methodological limitations, such as the absence of a control arm. Therefore, well-designed, controlled trials using clearly described interventions and relevant clinical outcomes are needed.
Laboratory testing represents the largest volume of medical activity and is considered to influence more than 70% of decision making in medical practice [2, 3]
Keywords: Laboratory utilization; Laboratory testing; Unnecessary laboratory utilization; Unnecessary laboratory testing; Reduction; Intervention