Curbing Unnecessary Vitamin D Testing.

Area of Science:

• Health Services Research
• Clinical Informatics
• Health Economics

Background:

• Vitamin D testing is frequently overused in U.S. health systems, often outside evidence-based guidelines.
• This overuse leads to significant costs and represents a low-value service in many regions.
• Clear guidance from organizations like the Endocrine Society and CMS exists but is not consistently followed.

Purpose of the Study:

• To reduce the volume of low-value vitamin D testing within an academic health system.
• To improve the appropriateness of vitamin D test ordering through a clinical decision support intervention.
• To assess the impact on testing rates, cost savings, and access to indicated testing.

Main Methods:

• A multidisciplinary working group designed an electronic health record best practice advisory (BPA).
• The BPA triggered at the point of order entry for vitamin D tests lacking approved indications, based on CMS coverage criteria.
• The intervention was supported by communication, measurement infrastructure, and provider feedback mechanisms.

Main Results:

• The proportion of indicated vitamin D tests increased from 45% pre-intervention to over 90% at one year post-implementation.
• The total number of vitamin D tests decreased by 25.3%, resulting in an estimated cost savings of nearly $112,000.
• Improvements were observed across various patient populations and care settings, with notable gains in outpatient and Medicaid populations.

Conclusions:

• A targeted clinical decision support tool, combined with communication and measurement, effectively reduces low-value vitamin D testing.
• The intervention improved ordering appropriateness while maintaining access to necessary testing, requiring no additional staffing or infrastructure.
• Sustained improvement relies on transparent metrics, engaged leadership, and addressing ordering habits and clinical nuances.