Chapter 49 : Test Utilization and Clinical Relevance

Abstract:

This chapter provides the reader with a strategy for making changes in laboratory utilization that are based on the clinical relevance of the tests. The information contained in the chapter specifically addresses strategies for dealing with political realities and other impediments to making change. The chapter helps the reader to become familiar with the concepts of clinical relevance and cost-effectiveness and how they are related, and to learn how to document the extent of the problem of laboratory test utilization, including relevant sources of information. It also discusses laboratory-based approaches and institution-based approaches to control laboratory test utilization. The chapter uses McLaughlin’s approach for the implementation of change in a patient care setting and another approach for integrating evidence-based medicine (EBM) with computer-based systems for controlling laboratory test utilization. Effective control of laboratory test utilization requires the use of more than one approach or intervention. Of the different types of interventions that have been evaluated, education appears to be the least effective. Feedback to providers appears to be the most effective intervention, particularly when it is computer-based and when it is linked to EBM. Effective interventions require the tracking of results, modification as indicated by data, and sustained effort.