A clinical decision support tool helped decrease routine vitamin D testing, a recent study reported.
Researchers designed an EHR-based clinical decision support tool for both inpatients and outpatients in a large safety-net system made up of 11 hospitals and 70 ambulatory centers in New York. The tool included a mandatory prompt requiring appropriate indications for 25-hydroxyvitamin D testing and a best practice advisory (BPA) triggered when a clinician placed an order for 25-hydroxyvitamin D level testing sooner than three months after a previous test. The study compared initial and repeated testing of vitamin D levels in a preintervention period (June 17, 2020, to June 13, 2021) and a postintervention period (June 14, 2021, to Aug. 28, 2022). It assessed variation in testing by hospital and clinic and analyzed BPA action rates by clinician type and specialty. The results were published May 2 by the Journal of General Internal Medicine.
The analysis included all inpatients and outpatients with at least one order for vitamin D testing, 65,550 in the preintervention period and 45,674 in the postintervention period. In the postintervention period, there were 44% and 46% reductions in inpatient and outpatient orders for vitamin D testing, respectively (P<0.001), while repeat testing at three months decreased by 61% and 48%, respectively (P<0.001). The accept rate for the BPA, defined as the retest cancellation rate, was 19.3% (3,152 of 16,332), while the 24-hour reorder rate was 6.3%, yielding a true accept rate of 13.0% (8.9% for inpatients and 13.9% for outpatients). True accept rates varied widely by clinician type and specialty.
The study was not controlled or randomized, and the authors did not use chart review to determine appropriateness of testing, they said. “This initiative successfully reduced 25(OH)D testing by 44–46% across 11 hospitals and 70 ambulatory centers in a safety net setting through the use of mandatory appropriate indications and a best practice advisory. Importantly, we introduced an intervention targeting a unique area of overuse: the repeat testing of 25(OH)D within a 3-month interval,” they wrote. The authors called for additional study to understand the appropriateness of orders for vitamin D testing as well as variation among clinician specialty and type.