Advancing diagnostic stewardship in contemporary medical practice

Area of Science:

• Medical Practice
• Healthcare Management
• Clinical Reasoning

Background:

• Over-testing, the inappropriate use of diagnostic tests, is prevalent in modern medicine.
• Factors contributing to over-testing include physician, patient, and system-related issues.
• Existing interventions like Choosing Wisely have shown limited success in reducing excessive diagnostic testing.

Purpose of the Study:

• Introduce "diagnostic stewardship" as a novel approach to responsible diagnostic test utilization.
• Explain the role of diagnostic stewardship in patient-centered and sustainable healthcare.
• Explore contributors to over-testing and its link to flawed clinical reasoning.

Main Methods:

• Literature review and conceptual analysis of diagnostic stewardship.
• Exploration of factors contributing to over-testing.
• Discussion of multi-level interventions for diagnostic testing behaviors.

Main Results:

• Diagnostic stewardship, adapted from antimicrobial stewardship, offers a framework for responsible test use.
• Over-testing is often rooted in flawed clinical reasoning under real-world conditions.
• Multi-level interventions are needed to address profligate diagnostic testing.

Conclusions:

• Diagnostic stewardship is crucial for enhancing patient-centered and sustainable healthcare.
• Addressing flawed clinical reasoning and implementing targeted interventions can curb over-testing.
• A shift towards responsible diagnostic practices is essential for healthcare improvement.