Modifying Provider Vitamin D Screening Behavior in Primary Care.

Area of Science:

• Clinical Practice
• Health Services Research
• Medical Economics

Background:

• Clinical evidence indicates limited benefit from routine vitamin D screening and treatment in the general population.
• Overutilization of diagnostic tests contributes to healthcare costs and potential patient harm.

Purpose of the Study:

• To evaluate the effectiveness of two interventions in reducing vitamin D test orders within primary care settings.
• To assess the impact of provider education and electronic health record (EHR) modifications on laboratory test ordering behavior.

Main Methods:

• An interrupted time series analysis was conducted on weekly vitamin D order rates from adult primary care encounters (June-December 2018).
• Interventions included an educational memo to providers and removal of the vitamin D test from EHR quick order screens.
• Order rates were analyzed across different provider types (physicians, PAs, NPs) in family medicine (FM) and internal medicine (IM).

Main Results:

• Overall vitamin D order rates decreased from 6.9% to 5.2% post-intervention.
• The educational intervention demonstrated significant relative decreases in ordering across all provider types (14-52% reduction).
• Annualized cost savings were estimated at approximately $1 million, with continued decreases in FM after interventions.

Conclusions:

• Evidence-based provider education via email is an effective strategy for modifying vitamin D test ordering behavior.
• Removing tests from EHR quick order screens had limited effectiveness in IM, suggesting challenges with alternative ordering pathways.