title: Data-Driven Iterative Refinement of Bone Marrow Testing Protocols Leads to Progressive Improvement in Cytogenetic and Molecular Test Utilization.
abstract: OBJECTIVE
  To determine the effect of iterative refinement of standard ordering protocols on test utilization and results for bone marrow biopsy specimens.
  
  
  METHODS
  Eighteen months of test utilization and result data were used to revise the protocols that determine cytogenetic and molecular test selection on bone marrow specimens and then compared with data obtained following protocol revision.
  
  
  RESULTS
  Revision of protocols resulted in reduction in total tests and associated charges, due to a decrease in tests both concordant and discordant with the protocols. These reductions only occurred in diseases for which revisions were made and were limited to cases in which reflex testing was performed. There was an increase in the fraction of positive tests, which was also limited to reflex testing.
  
  
  CONCLUSIONS
  Data-driven iterative revision of protocols further improves test utilization and performance, while reducing cost. Analysis of testing data can be used to continuously improve test ordering decisions.
authors: Adam C
authors: AC
authors: Seegmiller
authors: Annette S
authors: AS
authors: Kim
authors: Claudio A
authors: CA
authors: Mosse
authors: Aaron C
authors: AC
authors: Shaver
authors: Mary Ann
authors: MA
authors: Thompson
authors: Shaoying
authors: S
authors: Li
authors: David R
authors: DR
authors: Head
authors: Mary M
authors: MM
authors: Zutter
mesh_terms: D001706:Biopsy; D001853:Bone Marrow / Q000473:pathology*; D001854:Bone Marrow Cells / Q000473:pathology; D019046:Bone Marrow Neoplasms / Q000175:diagnosis* / Q000235:genetics / Q000473:pathology; D003365:Costs and Cost Analysis; D003582:Cytogenetics / Q000191:economics / Q000706:statistics & numerical data; D019317:Evidence-Based Medicine; D006405:Hematology; D006801:Humans; D010336:Pathology; D057089:Pathology, Molecular / Q000191:economics / Q000706:statistics & numerical data; D017410:Practice Guidelines as Topic
keywords: Bone marrow; Hematopathology; Test utilization