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Reducing Unnecessary Imaging and Pathology Tests: A Systematic Review.

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Reducing unnecessary pediatric imaging and pathology tests is crucial. Multifaceted interventions targeting families and clinicians show the most promise for decreasing low-value care.

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Area of Science:

  • Pediatric healthcare quality improvement
  • Health services research
  • Evidence-based medicine

Background:

  • Unnecessary imaging and pathology testing in children constitute low-value care.
  • These practices can negatively impact children and the healthcare system.
  • Systematic review is needed to identify effective interventions.

Purpose of the Study:

  • To systematically review interventions aimed at reducing unnecessary pediatric imaging and pathology testing.
  • To identify characteristics of effective interventions.

Main Methods:

  • Searched multiple databases (Medline, Embase, Cinahl, PubMed, Cochrane Library) and gray literature.
  • Included studies published in English from developed countries between 1996 and 2017.
  • Extracted data and assessed study quality using Cochrane risk of bias tool; graded evidence using Oxford Centre for Evidence-Based Medicine system.

Main Results:

  • Analyzed 64 articles, predominantly before-after studies.
  • Multifaceted interventions (3 components) showed greater reductions (45.0%) than 1 or 2 components.
  • Interventions targeting families and clinicians were more effective (61.9%) than those targeting clinicians only (30.0%).
  • Targeting imaging or pathology alone was more effective than targeting both simultaneously.

Conclusions:

  • Audit and feedback, system-based changes, and education are promising interventions.
  • Future research should employ rigorous designs beyond before-after studies.
  • Involving both clinicians and families in interventions is a novel and potentially effective approach.