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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