Decrease in unnecessary vitamin D testing using clinical decision support tools: making it harder to do the wrong...

Area of Science:

• Health Informatics
• Clinical Practice Guidelines
• Diagnostic Testing

Background:

• Vitamin D screening has risen due to perceived benefits, but often lacks evidence and increases healthcare costs.
• Inappropriate vitamin D testing contributes to unnecessary healthcare expenditure.
• Clinical decision support (CDS) tools offer a potential solution to optimize testing practices.

Purpose of the Study:

• To assess the impact of implementing three clinical decision support (CDS) tools on vitamin D testing rates.
• To evaluate changes in both overall and appropriate vitamin D screening post-intervention.

Main Methods:

• Three CDS tools were implemented within an electronic health record (EHR) system.
• Tools included updated screening guidelines, a clinician acknowledgement alert (hard stop), and removal of ordering shortcuts.
• Vitamin D screening rates were analyzed 6 months pre- and post-implementation.

Main Results:

• Overall vitamin D screening rates decreased significantly from 74.0 to 24.2 per 1000 members.
• The proportion of appropriate vitamin D screening tests increased from 56.2% to 69.7%.
• Inappropriate screening test proportion decreased from 43.8% to 30.3% post-intervention.

Conclusions:

• Clinical decision support tools can effectively reduce inappropriate vitamin D screening.
• The implemented CDS strategies were simple, inexpensive, and replicable.
• These approaches can help reduce unnecessary care and healthcare costs without compromising quality.