Vitamin D Best Practice Alert
Vitamin D is the hormone that enhances intestinal absorption of calcium and insures healthy bone formation. The best way to obtain vitamin D is through direct exposure of the skin to sunlight, because ultraviolet B rays stimulate the skin to synthesize vitamin D3. Some people do not have adequate exposure to sunlight and are at higher risk of developing vitamin D deficiency. Examples include individuals who:
- Live in latitudes >35o from the equator
- Live in heavily polluted cities
- Belong to cultures that require clothing that covers their entire body
- Are institutionalized or homebound
- Have dark skin
- Apply sunscreen compulsively
- Are elderly (decreased skin synthesis)
- Are obese (vitamin accumulates in fat)
Measurement of vitamin D levels is appropriate in these at-risk individuals to detect vitamin D deficiency and prescribe the correct dose of oral vitamin D supplementation. Repeat testing is warranted to ensure that vitamin D target levels are being maintained.
However, during the past decade physicians nationwide have been ordering routine vitamin D screening for the general population in spite of no evidence to support testing for vitamin D deficiency in healthy individuals. A recent article in the December 2017 issue of CAP Today, described how Drs. Julia Drees and Thomas Lorey at Kaiser Permanente intervened to decrease inappropriate vitamin D testing. Their laboratory was performing more than 2000 vitamin D tests every day. With the support of their clinical colleagues and health system executives, they created a passive best practice alert (BPA) in the electronic medical record (EMR) that was displayed at the time of test ordering and simply reminded providers that routine screening of healthy, low-risk individuals for vitamin D deficiency was not recommended. The alert also included a recommended daily intake of 600 to 800 international units of vitamin D. Within several months, vitamin D testing volumes decreased by 40% and has been sustained over time. Cost savings to the laboratory approach $1 million annually. However, Drs. Drees and Lorey stated that the real cost savings came in provider and patient time that was no longer being wasted on explaining the test, reviewing and explaining the results, and recommending appropriate vitamin D intake.
http://www.cap.org/web/home/resources/case-examples/individual-case?contentID=1-143805
