Effectiveness of Practices to Support Appropriate Laboratory Test Utilization: A Laboratory Medicine Best Practices...

Healthcare systems often face challenges related to the overuse or underuse of diagnostic laboratory tests. While prior research has identified potential strategies to address these issues, uncertainty remains about which interventions are most effective. This gap motivated a systematic review to evaluate evidence supporting specific practices for optimizing laboratory test utilization. Previous studies have explored tools like computerized systems and decision support, but no comprehensive synthesis has been available. The lack of clarity about which interventions work best has limited progress in this area. Researchers sought to address this by examining a broad range of practices. They aimed to determine which approaches are supported by strong evidence and which require further investigation. This uncertainty has driven the need for a structured analysis of available data. The goal was to provide actionable guidance for healthcare professionals and policymakers.

The purpose of this study was to assess the effectiveness of various practices in promoting appropriate use of clinical laboratory tests. The researchers focused on interventions such as computerized systems, decision support tools, and team-based approaches. They aimed to determine which strategies are most likely to reduce over- or underutilization of tests. The study followed a systematic review and meta-analysis approach to ensure comprehensive evaluation. It included a wide range of interventions and outcomes to capture diverse perspectives. The goal was to inform future research and clinical practice guidelines. By analyzing existing evidence, the authors sought to identify practices with strong support. This effort aimed to guide healthcare providers in making more informed decisions.

The study applied the CDC Laboratory Medicine Best Practices A6 cycle method to evaluate interventions. It included a systematic review of 83 eligible studies published in peer-reviewed journals. The authors identified practices such as CPOE, CDSS/CDST, and LTU teams as key areas of focus. They assessed the impact of these practices on test utilization outcomes. Outcomes included both system-level metrics and patient-related results. The researchers performed meta-analyses on 51 of the included studies. They evaluated the strength of evidence for each practice using predefined criteria. The approach ensured transparency and reproducibility of findings.

The strongest evidence supported modifications to existing CPOE systems and the use of reflex testing. Combined practices also showed promising results in improving test utilization. However, evidence for CDSS/CDST was insufficient to make a recommendation. Education, feedback, and test review had limited or no clear impact. LTU teams did not show consistent effectiveness across studies. The results highlight variability in the strength of evidence across practices. Some interventions showed high-quality support, while others lacked sufficient data. These findings suggest that further research is needed for several practices.

The authors concluded that modifications to CPOE systems and reflex testing are supported by strong evidence. They proposed that combined practices may also be effective in reducing inappropriate test use. However, no clear recommendations could be made for CDSS/CDST, education, or feedback. The findings suggest that these interventions require further investigation. LTU teams did not show consistent benefits based on available data. The authors emphasized the need for more rigorous studies on under-researched practices. They proposed that future work should focus on filling evidence gaps. These conclusions are based solely on the claims made in the reviewed literature.