Improving Test Ordering Must Also Address Underutilization of Appropriate Tests, Study Finds

Misuse of laboratory testing is common, but new research suggests that underutilization of appropriate tests may actually be more prevalent than overutilization of unnecessary tests. Analysis of 15 years of published data on appropriateness of test orders shows that overutilization of testing is a systematic problem and accounts for nearly one-third of ordered tests, but underutilization is as widespread, and understudied. By improving test ordering, particularly in the initial evaluation, more cost-effective care can be achieved, say the authors of the study published Nov. 15 in PLoS One. “It’s not ordering more tests or fewer tests that we should be aiming for, it’s ordering the right tests, however few or many that is,” says senior author Ramy Arnaout, M.D., D.Phil., in a statement. “Remember, lab tests are inexpensive. Ordering one more test or one less test isn’t going to ‘bend the curve,’ even if we do it across the board. It’s everything that happens next—the downstream visits, the surgeries, the hospital stays—that matters to patients and to the economy and should matter to us.” The researchers examined published studies (from 1997, the year of the last published review of lab tests, to 2012) to identify 42 papers covering 1.6 million […]