Background

The negative impact of unnecessary diagnostic tests on healthcare systems and patients has been widely recognized. Medical researchers in various countries have been devoting effort to reduce unnecessary diagnostic tests by using different types of interventions, including information and communications technology-based (ICT-based) intervention, educational intervention, audit and feedback, the introduction of guidelines or protocols, and the reward and punishment of staff. We conducted a review of ICT based interventions and a comparative analysis of their relative effectiveness in reducing unnecessary tests.

Method

A systematic Boolean search in PubMed, EMBase and EBSCOhost research databases was performed. Keyword search and citation analysis were also conducted. Empirical studies reporting ICT based interventions, and their implications on relative effectiveness in reducing unnecessary diagnostic tests (pathology tests or medical imaging) were evaluated independently by two reviewers based on a rigorously developed coding protocol.

Results

92 research articles from peer-reviewed journals were identified as eligible. 47 studies involved a single-method intervention and 45 involved multi-method interventions. Regardless of the number of interventions involved in the studies, ICT-based interventions were utilized by 71 studies and 59 of them were shown to be effective in reducing unnecessary testing. A clinical decision support (CDS) tool appeared to be the most adopted ICT approach, with 46 out of 71 studies using CDS tools. The CDS tool showed effectiveness in reducing test volume in 38 studies and reducing cost in 24 studies.

Conclusions

This review investigated five frequently utilized intervention methods, ICT-based, education, introduction of guidelines or protocols, audit and feedback, and reward and punishment. It provides in-depth analysis of the efficacy of different types of interventions and sheds insights about the benefits of ICT based interventions, especially those utilising CDS tools, to reduce unnecessary diagnostic testing. The replicability of the studies is limited due to the heterogeneity of the studies in terms of context, study design, and targeted types of tests.

中文翻译：

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关于不必要的诊断测试的系统文献综述：ICT使用的作用。

背景

不必要的诊断测试对医疗系统和患者的负面影响已得到广泛认可。各国医学研究人员一直致力于通过使用不同类型的干预措施来减少不必要的诊断测试，包括基于信息和通信技术（ICT）的干预，教育干预，审计和反馈，引入指南或协议，以及对工作人员的奖惩。我们对基于ICT的干预措施进行了回顾，并对它们在减少不必要的测试方面的相对有效性进行了比较分析。

方法

在PubMed，EMBase和EBSCOhost研究数据库中进行了系统的布尔搜索。还进行了关键词搜索和引文分析。两位研究人员根据经过严格开发的编码协议，独立评估了报告基于ICT干预措施的经验研究及其对减少不必要的诊断测试（病理学测试或医学影像）的相对有效性的影响。

结果

来自同行评审期刊的92篇研究文章被确定为合格。47项研究涉及单方法干预，45项涉及多方法干预。无论研究涉及多少干预措施，基于ICT的干预措施均被71项研究所利用，其中59项被证明有效地减少了不必要的测试。临床决策支持（CDS）工具似乎是最常用的ICT方法，在71个研究中有46个使用CDS工具。CDS工具在减少38个研究中的测试量和减少24个研究中的成本方面显示出了有效性。

结论

这项审查调查了五种常用的干预方法，基于信息通信技术的教育，教育，指南或协议的引入，审计和反馈以及奖惩。它提供了对不同类型干预措施功效的深入分析，并对基于ICT的干预措施（尤其是那些利用CDS工具减少不必要的诊断测试的干预措施）的益处产生了见解。由于研究在上下文，研究设计和目标测试类型方面的异质性，因此研究的可复制性受到限制。