Utilization review and management of laboratory testing in the ambulatory setting.

Physicians are probably guilty of misusing the clinical laboratory by either ordering too many tests (overutilization) or ordering too few tests (underutilization). This article is concerned mainly with overutilization in terms of searching for asymptomatic disease, too frequent monitoring of tests, ordering of test clusters, and a failure to use available information. The strategies considered to decrease overutilization include educational strategies, audit with feedback, cost-awareness strategies, rationing strategies, financial incentives and risk-sharing strategies, changes in the test request procedures, and administrative mandates of set protocols for laboratory test ordering.