• Michelle S Rockwell, YingXing Wu, Mariana Salamoun, Matthew W Hulver, and John W Epling.
• From Department of Human Nutrition, Foods, and Exercise, Virginia Tech, Blacksburg (MSR, MWH); Center for Transformative Research on Health Behaviors, Fralin Biomedical Research Institute at Virginia Tech Carilion, Roanoke (MSR, MWH, JWE); Health Analytics Research Team, Carilion Clinic, Roanoke, VA (YW, MS); Department of Family and Community Medicine, Carilion Clinic, Roanoke, VA (JWE); Virginia Tech Carilion School of Medicine, Roanoke (JWE). msrock@vt.edu.
• J Am Board Fam Med. 2020 Jul 1; 33 (4): 569-579.

BackgroundExponential increases in nonindicated, low-value vitamin D testing have been reported over the past 15 years. Downstream effects of such testing have not been well quantified.MethodsThe purpose of this study was to describe patterns of vitamin D testing within primary care of a large regional health system and to explore downstream health service utilization subsequent to nonindicated testing. Instances of vitamin D testing in 2015 were obtained by an electronic health record-automated search. A subset of patients for whom vitamin D testing was classified as nonindicated was identified, and vitamin D-related service utilization was tracked for 24 months.ResultsOf the 77,836 adult primary care patient records identified in 2015, vitamin D tests were conducted on 8,042 (10.3%), with 24.3% of tests yielding abnormal results. In the nonindicated test subset (n = 574), substantial clinical variability was illustrated by 85 care pathways and 26 vitamin D prescriptions. Forty-five percent of abnormal vitamin D lab tests were not followed up with repeat vitamin D tests. Vitamin D-related services (laboratory tests, imaging, and prescriptions) occurred at an average rate of 1.6 services per patient during the 24 months following nonindicated vitamin D testing. Some of these services were also classified as nonindicated.ConclusionsEvidence of a health service cascade following nonindicated vitamin D testing exists. Opportunities for improved consistency and quality of care related to vitamin D were observed in our health system. These results may inform clinical pathways related the prevention, evaluation, and treatment of low vitamin D.© Copyright 2020 by the American Board of Family Medicine.

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