• Hyung J Cho, Nessreen Mestari, Sigal Israilov, Da Wi Shin, Komal Chandra, Daniel Alaiev, Joseph Talledo, Surafel Tsega, Mariely Garcia, Milana Zaurova, ManchegoPeter AlarconPADepartment of Quality and Safe... more ty, NYC Health + Hospitals, New York, NY, USA.Department of Pediatrics, NYC Health + Hospitals/Kings County, Brooklyn, NY, USA., and Mona Krouss. less
• Department of Quality and Safety, Brigham and Women's Hospital, MA, Boston, USA. harryjcho@gmail.com.
• J Gen Intern Med. 2023 Aug 1; 38 (10): 232623322326-2332.

Background25-Hydroxyvitamin D testing is increasing despite national guidelines and Choosing Wisely recommendations against routine screening. Overuse can lead to misdiagnosis and unnecessary downstream testing and treatment. Repeat testing within 3 months is a unique area of overuse.ObjectiveTo reduce 25-hydroxyvitamin D testing in a large safety net system comprising 11 hospitals and 70 ambulatory centers.DesignThis was a quality improvement initiative with a quasi-experimental interrupted time series design with segmented regression.ParticipantsAll patients in the inpatient and outpatient settings with at least one order for 25-hydroxyvitamin D were included in the analysis.InterventionsAn electronic health record clinical decision support tool was designed for inpatient and outpatient orders and involved two components: a mandatory prompt requiring appropriate indications and a best practice advisory (BPA) focused on repeat testing within 3 months.Main MeasuresThe pre-intervention period (6/17/2020-6/13/2021) was compared to the post-intervention period (6/14/2021-8/28/2022) for total 25-hydroxyvitamin D testing, as well as 3-month repeat testing. Hospital and clinic variation in testing was assessed. Additionally, best practice advisory action rates were analyzed, separated by clinician type and specialty.Key ResultsThere were 44% and 46% reductions in inpatient and outpatient orders, respectively (p < 0.001). Inpatient and outpatient 3-month repeat testing decreased by 61% and 48%, respectively (p < 0.001). The best practice advisory true accept rate was 13%.ConclusionThis initiative successfully reduced 25-hydroxyvitamin D testing through the use of mandatory appropriate indications and a best practice advisory focusing on a unique area of overuse: the repeat testing within a 3-month interval. There was wide variation among hospitals and clinics and variation among clinician types and specialties regarding actions to the best practice advisory.© 2023. The Author(s), under exclusive licence to Society of General Internal Medicine.

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