Introduction: Innovations in modern medicine have led to the development of many effective laboratory tests for diagnosis and monitoring of disease. However, research suggests that 20-50% of tests may be inappropriately ordered. Test-ordering intervention development experts i.e. those staff at individual institutions who are tasked with designing different approaches to improving test-ordering practice, often have large datasets on the test-ordering practices within their jurisdiction as part of clinical care, but often have no clear guidance on how to choose which tests are worthy of intervention. These staff can include both clinicians and knowledge translation experts working in separately or in tandem to improve test-ordering behaviours at their institutions. The overall aim of this research is to build a prioritization framework to assist healthcare organizations in deciding which tests are worth targeting for intervention.
Methods: The first stage of this project was a scoping review of the literature, the purpose of which was to determine the factors and processes used by intervention developers to choose which tests to target for intervention. Identification of these articles allowed for the descriptive analysis of the factors and processes reported in making the test-ordering decisions. The second stage involved semi-structured interviews with intervention development experts and contains information on their experiences with measuring and prioritizing among factors, as well as which processes they found to be most effective in making the decision on which tests to target for intervention.
Results: By exploring all relevant guideline statements and related empirical studies, we gathered a wide range of factors to consider when deciding which test(s) to target for intervention. Overall, we identified 18 factors in our review and 30 in our interviews, highlighting the potential complexity of these decisions. While our studies were not the first to demonstrate that targeting tests is complex and that many factors must go into the decision of deciding which tests to target, our work has identified the most comprehensive range of factors available. We also explored processes reported by the studies that led to these decisions. Of the nine processes identified in our review, some were identified in a majority of cases (literature review, followed by clinical standard-implicit and consensus process), and other processes far more infrequently. Our interviews with relevant stakeholders demonstrated that the interviewees used 18 unique processes to decide which tests to target for intervention and helped to prioritize among the processes that are most effective in making these decisions.
Conclusion: The current work prepares the way to develop a framework designed to help intervention developers choose which tests can most efficiently result in improved test-ordering processes. After additional interviews to ensure saturation of themes, we will be able to proceed with framework development, perhaps involving a consensus process of all relevant stakeholders. We hope to widely distribute our framework to assist intervention development experts working in a wide variety of milieus to help them decide which tests are worth targeting for intervention such that their respective institutions can provide the highest quality of care to patients.
| Identifer | oai:union.ndltd.org:uottawa.ca/oai:ruor.uottawa.ca:10393/42859 |
| Date | 28 October 2021 |
| Creators | Podolsky, Eyal |
| Contributors | Brehaut, Jamie |
| Publisher | Université d'Ottawa / University of Ottawa |
| Source Sets | Université d’Ottawa |
| Language | English |
| Detected Language | English |
| Type | Thesis |
| Format | application/pdf |
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