Reducing unnecessary imaging and pathology tests: a systematic review

Harriet Hiscock, Rachel Jane Neely, Hayley Warren, Jason Soon, Andrew Georgiou

Research output: Contribution to journalReview articleResearchpeer-review

Abstract

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.

LanguageEnglish
Article numbere20172862
Pages1-22
Number of pages22
JournalPediatrics
Volume141
Issue number2
DOIs
Publication statusPublished - 1 Feb 2018

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Cite this

Hiscock, Harriet ; Neely, Rachel Jane ; Warren, Hayley ; Soon, Jason ; Georgiou, Andrew. / Reducing unnecessary imaging and pathology tests : a systematic review. In: Pediatrics. 2018 ; Vol. 141, No. 2. pp. 1-22.
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abstract = "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.",
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Hiscock, H, Neely, RJ, Warren, H, Soon, J & Georgiou, A 2018, 'Reducing unnecessary imaging and pathology tests: a systematic review', Pediatrics, vol. 141, no. 2, e20172862, pp. 1-22. https://doi.org/10.1542/peds.2017-2862

Reducing unnecessary imaging and pathology tests : a systematic review. / Hiscock, Harriet; Neely, Rachel Jane; Warren, Hayley; Soon, Jason; Georgiou, Andrew.

In: Pediatrics, Vol. 141, No. 2, e20172862, 01.02.2018, p. 1-22.

Research output: Contribution to journalReview articleResearchpeer-review

TY - JOUR

T1 - Reducing unnecessary imaging and pathology tests

T2 - Pediatrics

AU - Hiscock, Harriet

AU - Neely, Rachel Jane

AU - Warren, Hayley

AU - Soon, Jason

AU - Georgiou, Andrew

PY - 2018/2/1

Y1 - 2018/2/1

N2 - 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.

AB - 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.

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DO - 10.1542/peds.2017-2862

M3 - Review article

VL - 141

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JF - Pediatrics

SN - 0031-4005

IS - 2

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