Principles for high-quality, high-value testing
Open accessAbstract
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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An oPMN level >1.43 × 10^6/mL is a potentially useful test to differentiate S3P and GCP from S2P and GBP, but this requires further investigation.
“Given that the summation of Se and Sp for oPMN levels was <1.5, 45 our results suggest that an oPMN level >1.43 × 106/mL is a potentially useful test to differentiate S3P and GCP from S2P and GBP; however, this requires further investigation.”
From Prognostic utility of oral neutrophil counts in high-risk periodontitis: A retrospective study (2025) · cites this paper as [45]
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- Authors
- Power, M., Fell, G., & Wright, M.
- Affiliations
- Newcastle upon Tyne Hospitals NHS Foundation Trust (GB)
- Airedale NHS Foundation Trust (GB)
- Corresponding author
- Power, Michael
- Venue
- Evidence Based Medicine
- Publisher
- BMJ
- Published
- 2012-06-27
- Volume
- 18
- Issue
- 1
- Pages
- 5-10
- ISSN
- 1356-5524 (ISSN-L)
- 1473-6810
- PMC
- PMC3585491
- OpenAlex
- W2051681038
- Cited by
- 394
- References
- 24
- Citations by year
- 2026: 40 · 2025: 84 · 2024: 82 · 2023: 83 · 2022: 58 · 2021: 33 · 2020: 4 · 2019: 2 · 2018: 4 · 2014: 2 · 2013: 2
- FWCI
- 2.27
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- cc-by-nc
- Locations
- BMJ Evidence-Based Medicine (publishedVersion, cc-by-nc)
- Europe PMC (PubMed Central) (publishedVersion, other-oa)
- PubMed Central (publishedVersion, cc-by-nc)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Health Professions › General Health Professions › Healthcare cost, quality, practices
- Health Sciences › Medicine › Family Practice › Clinical Reasoning and Diagnostic Skills
- Health Sciences › Medicine › Physiology › Clinical Laboratory Practices and Quality Control
- Keywords
- overuse of diagnostic testing, high-value care, evidence-based practice, test performance, overdiagnosis, patient-centered care, cognitive biases, medical training, NHS doctors, diagnostic imaging
- MeSH terms
- Cost-Benefit Analysis, Diagnostic Tests, Routine, Humans, Predictive Value of Tests, Quality of Health Care, Sensitivity and Specificity, Evidence-Based Medicine, Uncertainty
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