The landscape of inappropriate laboratory testing: a 15-year meta-analysis

The landscape of inappropriate laboratory testing: a 15-year meta-analysis

Laboratory testing is the single highest-volume medical activity and drives clinical decision-making across medicine. However, the overall landscape of inappropriate testing, which is thought to be dominated by repeat testing, is unclear. Systematic differences in initial vs. repeat testing, measure...

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Bibliographic Details
Published in:PloS one 2013-11, Vol.8 (11), p.e78962-e78962
Main Authors: Zhi, Ming, Ding, Eric L, Theisen-Toupal, Jesse, Whelan, Julia, Arnaout, Ramy
Format: Article
Language:eng
Subjects:
Clinical decision making
Clinical Laboratory Techniques
Cost control
Criteria
Decision making
Diagnostic Errors
Evidence-based medicine
Health care policy
Hematology
Hospitals
Humans
Laboratories
Laboratory tests
Medical schools
Medicine
Meta-analysis
Microbiology
Pathology
Primary care
Statistical analysis
Statistical significance
Studies
Systematic review
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Summary:Laboratory testing is the single highest-volume medical activity and drives clinical decision-making across medicine. However, the overall landscape of inappropriate testing, which is thought to be dominated by repeat testing, is unclear. Systematic differences in initial vs. repeat testing, measurement criteria, and other factors would suggest new priorities for improving laboratory testing. A multi-database systematic review was performed on published studies from 1997-2012 using strict inclusion and exclusion criteria. Over- vs. underutilization, initial vs. repeat testing, low- vs. high-volume testing, subjective vs. objective appropriateness criteria, and restrictive vs. permissive appropriateness criteria, among other factors, were assessed. Overall mean rates of over- and underutilization were 20.6% (95% CI 16.2-24.9%) and 44.8% (95% CI 33.8-55.8%). Overutilization during initial testing (43.9%; 95% CI 35.4-52.5%) was six times higher than during repeat testing (7.4%; 95% CI 2.5-12.3%; P for stratum difference
ISSN:1932-6203
1932-6203