| Description |
Background: Vitamin D screening is often overutilized in healthy individuals without risk factors, despite national guidelines recommending targeted screening for those with underlying medical conditions that increase the risk of deficiency. Vitamin D deficiency screening rates have risen in recent decades, often conducted without clear clinical indications. This initiative aimed to increase clinician awareness and adherence to evidence-based guidelines, optimizing screening for those most likely to benefit while minimizing unnecessary screening in low-risk individuals. Local Problem: Before this initiative, a student health clinic on an urban campus lacked standardized vitamin D deficiency screening guidelines. Clinicians reported low confidence in their ability to screen patients according to guidelines, explain associated risk factors, and educate patients on vitamin D deficiency prevention. Methods: This quality improvement initiative was implemented in five phases. Pre- and postimplementation clinician surveys assessed clinician awareness of guidelines and attitudes towards screening and measured feasibility, usability, and satisfaction. Electronic health record (EHR) chart reviews compared clinic orders for vitamin D screening before and after implementation. Interventions: Based on the current literature, an evidence-based vitamin D screening guideline, including a screening algorithm flowsheet and patient education pamphlet, was developed. The guideline was presented in an education session, discussed with clinicians, and adjusted to meet the clinic's needs. Implementation occurred over 13 weeks. Results: Vitamin D screening in low-risk individuals without documented risk factors decreased from 8% pre-implementation to 1% post-implementation, demonstrating improved clinician adherence to evidence-based guidelines. Opportunities to improve screening for high-risk individuals were limited. Clinician confidence increased post-implementation, with all (100%, n=6) reporting confidence in explaining risk factors and providing patient education. Knowledge assessment scores improved by 37% post-implementation. Most clinicians (83%) agreed that the guideline was easy to understand, useful in practice, and intended to integrate it in their practice. Satisfaction with the implementation was high (83%), the project was deemed feasible due to a 100% retention rate of participants, and most stated high protocol usability (83%). Conclusion: This quality improvement initiative improved student health clinicians' awareness of and adherence to evidence-based vitamin D screening guidelines, reducing unnecessary screenings in low-risk individuals. Further studies are needed to evaluate vitamin D screening guidelines in more diverse clinical settings among a broader range of healthcare providers. |
