title: Laboratory medicine best practices: systematic evidence review and evaluation methods for quality improvement.
abstract: OBJECTIVE
  To develop methods for systematically reviewing evidence for identifying effective laboratory medicine (LM) practices associated with improved healthcare quality outcomes.
  
  
  CONCLUSIONS
  Although many evidence-evaluation systems have been developed, none are designed to include and rate healthcare quality improvement studies to identify evidence-based practices that improve patient safety and LM quality.
  
  
  METHODS
  Validated evidence-based medicine methods established by governmental agencies, the Guide to Community Preventive Services, and others were adapted for the LM field. Key methods modifications included (a) inclusion of quality improvement study designs; (b) mechanisms for inclusion of unpublished evidence, (c) combining of individual ratings of study quality, effect size, and relevance of outcome measures to evaluate consistency of practice evidence; and (d) deriving an overall strength rating to support evidence-based best practice recommendations. The methods follow the process steps of: ask; acquire; appraise; analyze; apply; and assess. Expert panels used the systematic evidence review results on practice effectiveness for improving healthcare quality outcomes consistent with the Institute of Medicine's healthcare quality aims (safe, timely, effective, equitable, efficient, and patient-centered).
  
  
  CONCLUSIONS
  Adapting and developing methods from validated systems and applying them to systematically review and evaluate practices in LM by using published and unpublished studies is feasible. With these methods, evidence from quality improvement studies can be systematically synthesized and summarized to identify effective LM practices. Practical and scientifically validated demonstration of a positive impact on outcomes ensures that practitioners, policy makers, and decision makers at all levels have the evidence needed for improving healthcare quality and public health.
authors.affiliation: University of Maryland School of Medicine, Baltimore, MD 21201, USA. rchristenson@umm.edu
authors.forename: Robert H
authors.initials: RH
authors.lastname: Christenson
authors.forename: Susan R
authors.initials: SR
authors.lastname: Snyder
authors.forename: Colleen S
authors.initials: CS
authors.lastname: Shaw
authors.forename: James H
authors.initials: JH
authors.lastname: Derzon
authors.forename: Robert S
authors.initials: RS
authors.lastname: Black
authors.forename: Diana
authors.initials: D
authors.lastname: Mass
authors.forename: Paul
authors.initials: P
authors.lastname: Epner
authors.forename: Alessandra M
authors.initials: AM
authors.lastname: Favoretto
authors.forename: Edward B
authors.initials: EB
authors.lastname: Liebow
mesh_terms: D019411:Clinical Laboratory Techniques / Q000592:standards*; D055317:Evidence-Based Practice; D011785:Quality Assurance, Health Care / Q000592:standards*; D012196:Review Literature as Topic