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J Am Med Inform Assoc. 2017 Jul 1;24(4):776-780. doi: 10.1093/jamia/ocw182.

Decrease in unnecessary vitamin D testing using clinical decision support tools: making it harder to do the wrong thing.

Author information

1
Northwest Permanente, Portland, OR, USA.
2
Kaiser Permanente Center for Health Research, Portland, OR, USA.

Abstract

Objective:

To evaluate the impact of clinical decision support (CDS) tools on rates of vitamin D testing. Screening for vitamin D deficiency has increased in recent years, spurred by studies suggesting vitamin D's clinical benefits. Such screening, however, is often unsupported by evidence and can incur unnecessary costs.

Materials and Methods:

We evaluated how rates of vitamin D screening changed after we implemented 3 CDS tools in the electronic health record (EHR) of a large health plan: (1) a new vitamin D screening guideline, (2) an alert that requires clinician acknowledgement of current guidelines to continue ordering the test (a "hard stop"), and (3) a modification of laboratory ordering preference lists that eliminates shortcuts. We assessed rates of overall vitamin D screening and appropriate vitamin D screening 6 months pre- and post-intervention.

Results:

Vitamin D screening rates decreased from 74.0 tests to 24.2 tests per 1000 members ( P  < .0001). The proportion of appropriate vitamin D screening tests increased from 56.2% to 69.7% ( P  < .0001), and the proportion of inappropriate screening tests decreased from 43.8% pre-implementation to 30.3% post-implementation ( P  < .0001).

Discussion:

To our knowledge, this is the first demonstration of how CDS can reduce rates of inappropriate vitamin D screening. We used 3 straightforward, inexpensive, and replicable CDS approaches. We know of no previous research on the impact of removing options from a preference list.

Conclusion:

Similar approaches could be used to reduce unnecessary care and decrease costs without reducing quality of care.

KEYWORDS:

clinical decision support; ordering preference list; vitamin D screening

PMID:
28339692
DOI:
10.1093/jamia/ocw182
[Indexed for MEDLINE]

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