Reducing Unnecessary Imaging and Pathology Tests : A Systematic Review
Copyright © 2018 by the American Academy of Pediatrics..
CONTEXT: Unnecessary imaging and pathology procedures represent low-value care and can harm children and the health care system.
OBJECTIVE: To perform a systematic review of interventions designed to reduce unnecessary pediatric imaging and pathology testing.
DATA SOURCES: We searched Medline, Embase, Cinahl, PubMed, Cochrane Library, and gray literature.
STUDY SELECTION: Studies we included were: reports of interventions to reduce unnecessary imaging and pathology testing in pediatric populations; from developed countries; written in the English language; and published between January 1, 1996, and April 29, 2017.
DATA EXTRACTION: Two researchers independently extracted data and assessed study quality using a Cochrane group risk of bias tool. Level of evidence was graded using the Oxford Centre for Evidence-Based Medicine grading system.
RESULTS: We found 64 articles including 44 before-after, 14 interrupted time series, and 1 randomized controlled trial. More effective interventions were (1) multifaceted, with 3 components (mean relative reduction = 45.0%; SD = 28.3%) as opposed to 2 components (32.0% [30.3%]); or 1 component (28.6%, [34.9%]); (2) targeted toward families and clinicians compared with clinicians only (61.9% [34.3%] vs 30.0% [32.0%], respectively); and (3) targeted toward imaging (41.8% [38.4%]) or pathology testing only (48.8% [20.9%]), compared with both simultaneously (21.6% [29.2%]).
LIMITATIONS: The studies we included were limited to the English language.
CONCLUSIONS: Promising interventions include audit and feedback, system-based changes, and education. Future researchers should move beyond before-after designs to rigorously evaluate interventions. A relatively novel approach will be to include both clinicians and the families they manage in such interventions.
| Errataetall: | |
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| Medienart: |
E-Artikel |
| Erscheinungsjahr: |
2018 |
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| Erschienen: |
2018 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:141 |
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| Enthalten in: |
Pediatrics - 141(2018), 2 vom: 30. Feb. |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Hiscock, Harriet [VerfasserIn] |
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| Links: |
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| Themen: |
Journal Article |
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| Anmerkungen: |
Date Completed 21.01.2019 Date Revised 21.01.2019 published: Print CommentIn: Pediatrics. 2018 Feb;141(2):. - PMID 29382687 Citation Status MEDLINE |
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| doi: |
10.1542/peds.2017-2862 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM280428375 |
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| 500 | |a Date Revised 21.01.2019 | ||
| 500 | |a published: Print | ||
| 500 | |a CommentIn: Pediatrics. 2018 Feb;141(2):. - PMID 29382687 | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a Copyright © 2018 by the American Academy of Pediatrics. | ||
| 520 | |a CONTEXT: Unnecessary imaging and pathology procedures represent low-value care and can harm children and the health care system | ||
| 520 | |a OBJECTIVE: To perform a systematic review of interventions designed to reduce unnecessary pediatric imaging and pathology testing | ||
| 520 | |a DATA SOURCES: We searched Medline, Embase, Cinahl, PubMed, Cochrane Library, and gray literature | ||
| 520 | |a STUDY SELECTION: Studies we included were: reports of interventions to reduce unnecessary imaging and pathology testing in pediatric populations; from developed countries; written in the English language; and published between January 1, 1996, and April 29, 2017 | ||
| 520 | |a DATA EXTRACTION: Two researchers independently extracted data and assessed study quality using a Cochrane group risk of bias tool. Level of evidence was graded using the Oxford Centre for Evidence-Based Medicine grading system | ||
| 520 | |a RESULTS: We found 64 articles including 44 before-after, 14 interrupted time series, and 1 randomized controlled trial. More effective interventions were (1) multifaceted, with 3 components (mean relative reduction = 45.0%; SD = 28.3%) as opposed to 2 components (32.0% [30.3%]); or 1 component (28.6%, [34.9%]); (2) targeted toward families and clinicians compared with clinicians only (61.9% [34.3%] vs 30.0% [32.0%], respectively); and (3) targeted toward imaging (41.8% [38.4%]) or pathology testing only (48.8% [20.9%]), compared with both simultaneously (21.6% [29.2%]) | ||
| 520 | |a LIMITATIONS: The studies we included were limited to the English language | ||
| 520 | |a CONCLUSIONS: Promising interventions include audit and feedback, system-based changes, and education. Future researchers should move beyond before-after designs to rigorously evaluate interventions. A relatively novel approach will be to include both clinicians and the families they manage in such interventions | ||
| 650 | 4 | |a Journal Article | |
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| 650 | 4 | |a Systematic Review | |
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| 700 | 1 | |a Soon, Jason |e verfasserin |4 aut | |
| 700 | 1 | |a Georgiou, Andrew |e verfasserin |4 aut | |
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