Bad Tests Die Slowly: The Myelin Basic Protein Example.

Area of Science:

• Neurology
• Clinical Chemistry
• Laboratory Medicine

Background:

• Multiple sclerosis (MS) diagnostic stewardship is crucial for optimizing laboratory test utilization.
• Myelin basic protein (MBP) testing has questionable clinical utility, prompting a review of its use in MS panels.
• Oligoclonal bands (OCB) are a key biomarker for MS diagnosis, necessitating accurate ordering practices.

Purpose of the Study:

• To evaluate the impact of two interventions on ordering trends for MBP and OCB in MS testing.
• To assess changes in practice variation for MS diagnostic testing following the interventions.
• To determine the effectiveness of stewardship efforts in improving the use of MS-related laboratory tests.

Main Methods:

• A national reference laboratory implemented two interventions: an educational publication on MBP utility and removal of MBP from the MS testing panel.
• Ordering data for MBP and OCB from 1710 clients (academic and community hospitals) were analyzed from 2008 to 2018.
• Practice variation was assessed by comparing the ratio of OCB to OCB + MBP orders (%OCB) before and after interventions.

Main Results:

• The percentage of OCB orders increased from approximately 50% (2000-2011) to 67% in 2018.
• Analysis revealed a shift in practice variation, with clients increasingly favoring OCB alone over the combined OCB and MBP panel after 2014.
• The interventions demonstrated a measurable positive effect on MS testing ordering trends over a decade.

Conclusions:

• The implemented stewardship interventions positively influenced MS testing ordering patterns.
• Despite positive effects, MBP's limited clinical utility suggests that stronger interventions may be required for substantial changes in ordering behavior.
• Continued efforts in laboratory test stewardship are essential for optimizing diagnostic accuracy and resource utilization in MS management.