Limits...
Principles for high-quality, high-value testing.

Power M, Fell G, Wright M - Evid Based Med (2012)

Bottom Line: A survey of doctors working in two large NHS hospitals identified over 120 laboratory tests, imaging investigations and investigational procedures that they considered not to be overused.A common suggestion in this survey was that more training was required.The core principles are: (1) Base testing practices on the best available evidence. (2) Apply the evidence on test performance with careful judgement. (3) Test efficiently. (4) Consider the value (and affordability) of a test before requesting it. (5) Be aware of the downsides and drivers of overdiagnosis. (6) Confront uncertainties. (7) Be patient-centred in your approach. (8) Consider ethical issues. (9) Be aware of normal cognitive limitations and biases when testing. (10) Follow the 'knowledge journey' when teaching and learning these core principles.

View Article: PubMed Central - PubMed

Affiliation: Pharmacy Department, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK. Michael.Power@NUTH.NHS.UK

ABSTRACT
A survey of doctors working in two large NHS hospitals identified over 120 laboratory tests, imaging investigations and investigational procedures that they considered not to be overused. A common suggestion in this survey was that more training was required. And, this prompted the development of a list of core principles for high-quality, high-value testing. The list can be used as a framework for training and as a reference source. The core principles are: (1) Base testing practices on the best available evidence. (2) Apply the evidence on test performance with careful judgement. (3) Test efficiently. (4) Consider the value (and affordability) of a test before requesting it. (5) Be aware of the downsides and drivers of overdiagnosis. (6) Confront uncertainties. (7) Be patient-centred in your approach. (8) Consider ethical issues. (9) Be aware of normal cognitive limitations and biases when testing. (10) Follow the 'knowledge journey' when teaching and learning these core principles.

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Reclassification possibilities with the last in a series of tests. This figure is only reproduced in colour in the online version.
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Related In: Results  -  Collection

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EBMED2012100645F1: Reclassification possibilities with the last in a series of tests. This figure is only reproduced in colour in the online version.

Mentions: Information on the relative performance of tests may be easier to obtain. Tests will usually be done in a sequence, beginning with the cheapest and least invasive (ie, history and physical examination) as illustrated in figure 6. When a diagnostic test is performed, it will classify people as having or not having a condition. As all tests can have false-positive and false-negative results, the next test in a series will reclassify some people correctly and others incorrectly as illustrated in figure 1.


Principles for high-quality, high-value testing.

Power M, Fell G, Wright M - Evid Based Med (2012)

Reclassification possibilities with the last in a series of tests. This figure is only reproduced in colour in the online version.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC3585491&req=5

EBMED2012100645F1: Reclassification possibilities with the last in a series of tests. This figure is only reproduced in colour in the online version.
Mentions: Information on the relative performance of tests may be easier to obtain. Tests will usually be done in a sequence, beginning with the cheapest and least invasive (ie, history and physical examination) as illustrated in figure 6. When a diagnostic test is performed, it will classify people as having or not having a condition. As all tests can have false-positive and false-negative results, the next test in a series will reclassify some people correctly and others incorrectly as illustrated in figure 1.

Bottom Line: A survey of doctors working in two large NHS hospitals identified over 120 laboratory tests, imaging investigations and investigational procedures that they considered not to be overused.A common suggestion in this survey was that more training was required.The core principles are: (1) Base testing practices on the best available evidence. (2) Apply the evidence on test performance with careful judgement. (3) Test efficiently. (4) Consider the value (and affordability) of a test before requesting it. (5) Be aware of the downsides and drivers of overdiagnosis. (6) Confront uncertainties. (7) Be patient-centred in your approach. (8) Consider ethical issues. (9) Be aware of normal cognitive limitations and biases when testing. (10) Follow the 'knowledge journey' when teaching and learning these core principles.

View Article: PubMed Central - PubMed

Affiliation: Pharmacy Department, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK. Michael.Power@NUTH.NHS.UK

ABSTRACT
A survey of doctors working in two large NHS hospitals identified over 120 laboratory tests, imaging investigations and investigational procedures that they considered not to be overused. A common suggestion in this survey was that more training was required. And, this prompted the development of a list of core principles for high-quality, high-value testing. The list can be used as a framework for training and as a reference source. The core principles are: (1) Base testing practices on the best available evidence. (2) Apply the evidence on test performance with careful judgement. (3) Test efficiently. (4) Consider the value (and affordability) of a test before requesting it. (5) Be aware of the downsides and drivers of overdiagnosis. (6) Confront uncertainties. (7) Be patient-centred in your approach. (8) Consider ethical issues. (9) Be aware of normal cognitive limitations and biases when testing. (10) Follow the 'knowledge journey' when teaching and learning these core principles.

Show MeSH