A new study examining 15 years' worth of published research reveals some surprising findings about the humble blood test. Led by investigators at Beth Israel Deaconess Medical Center and reported online in PLOS ONE, the large-scale analysis of 1.6 million results from 46 of medicine's 50 most commonly ordered lab tests finds that, on average, 30% of all tests are probably unnecessary. Even more surprising, the results suggest that equally as many necessary tests may be going unordered.
While the study authors found both overuse and underuse to be prevalent problems throughout laboratory testing, the overall findings point to a bigger issue, senior author Ramy Arnaout, MD, PhD, says. “It's not ordering more tests or fewer tests that we should be aiming for,” he notes. “It's ordering the right tests, however few or many that is.” He stresses that test ordering decisions have far-reaching consequences: “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.”
To conduct the study, the authors undertook a thorough review of the medical literature. They scoured databases matching terms such as “laboratory,” “blood test,” “utilization,” “overuse,” and “underuse.” Further refinement led to an examination of 42 papers covering 1.6 million orders of the 46 commonly ordered lab tests. From this data, they set about estimating the overall prevalence of inappropriate testing, including overuse and underuse. They distinguished between inappropriate initial testing and inappropriate repeat testing, established criteria that influence how doctors order lab tests, and examined their final outcomes in the context of these criteria. Read the article.
