Reducing 25-Hydroxyvitamin D Testing in a Large, Urban Safety Net System

Area of Science:

• Clinical Chemistry
• Health Services Research
• Quality Improvement

Background:

• Increasing 25-hydroxyvitamin D testing contradicts national guidelines and Choosing Wisely recommendations.
• Overutilization leads to potential misdiagnosis, unnecessary downstream testing, and treatment.
• Repeat testing within 3 months represents a specific area of overuse.

Purpose of the Study:

• To decrease 25-hydroxyvitamin D testing within a large safety net healthcare system.
• To implement and evaluate a clinical decision support tool to curb unnecessary testing.

Main Methods:

• A quality improvement initiative using a quasi-experimental interrupted time series design.
• Implementation of an electronic health record clinical decision support tool with mandatory indication prompts and a best practice advisory (BPA) for repeat testing.
• Analysis of testing data pre- and post-intervention, including assessment of BPA action rates by clinician type and specialty.

Main Results:

• Significant reductions in both inpatient (44%) and outpatient (46%) 25-hydroxyvitamin D orders (p < 0.001).
• Substantial decreases in 3-month repeat testing for both inpatient (61%) and outpatient (48%) settings (p < 0.001).
• A true accept rate of 13% for the best practice advisory was observed.

Conclusions:

• The implemented initiative effectively reduced 25-hydroxyvitamin D testing through mandatory indications and a BPA targeting repeat testing.
• Significant variation in testing practices and BPA response existed across different hospitals, clinics, clinician types, and specialties.
• The findings highlight the potential for targeted interventions to optimize laboratory test utilization.