Comparison of four methods (L/S ratio, TDx FLM, lamellar bodies, PG) for fetal lung maturity using meta-analysis

Multiple factors in the past encouraged physicians to order laboratory tests excessively and perhaps even abusively. The shift in the financing of health care to managed care and capitation will create an environment where physicians will be more receptive to laboratory efforts to influence their test ordering behavior toward cost-effectiveness. Various strategies to modify physicians' test-ordering behavior have met with only mixed success due to lack of data to support the desired result: reducing laboratory tests that are not specifically indicated for a particular patient. The current dynamics in the health care industry in general and in the clinical laboratory in particular place increasing value on information about the overall process of health-care delivery. This information can be derived from data from what were formerly considered discrete, transactional events, i.e., specific publications. Combining data from articles dealing with the same subject (meta-analysis) is increasingly being used to assess the value of the overall process of delivery (the outcome). Although considered ¿arm chair¿ research, meta-analysis is an important tool in evaluating the worth of a method in patient care. We chose to evaluate, given the current literature, which laboratory test--lecithin/ sphingomyelin ratio, surfactant/albumin ratio, lamellar bodies, or phosphatidylglycerol--is the best and most cost effective method to screen for fetal lung maturity. We identified all pertinent literature from 1966 to the present using a search of Medline.