ArticleJournal of the American Medical Informatics Association : JAMIA2017
Decrease in unnecessary vitamin D testing using clinical decision support tools: making it harder to do the wrong thing.
Article in Journal of the American Medical Informatics Association : JAMIA, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 31 papers, 2 of them syntheses that pooled it.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
31 citing papers in PubMed, 2 syntheses or guidelines pooled it.
- The Impact of Choosing Wisely Interventions on Low-Value Medical Services: A Systematic Review.The Milbank quarterly · 2021Pooled it
- Efficacy and unintended consequences of hard-stop alerts in electronic health record systems: a systematic review.Journal of the American Medical Informatics Association : JAMIA · 2018Pooled it
- Interruptive Electronic Alerts for Choosing Wisely Recommendations: A Cluster Randomized Controlled Trial.Journal of the American Medical Informatics Association : JAMIA · 2022Trial
- Comparison of tWo hospital quality Improvement interventions on inappropriate measurement and SupplEmentation of vitamin D: the WISE-D study.BMC geriatrics · 2026Article
- Leveraging the electronic health records to mitigate the effects of a nation-wide shortage of blood culture bottles.JAMIA open · 2026Article
- Rethinking Vitamin D Deficiency: Controversies and Practical Guidance for Clinical Management.Nutrients · 2025Review
- The impact of Choosing WiselyBMC health services research · 2025Article
- Factors Associated with Vitamin D Testing: A Population-Based Cohort Study in Queensland, Australia.Nutrients · 2025Article
- The impact of demand management on vitamin D testing.Biochemia medica · 2025Article
- Consensus Statement on Vitamin D Status Assessment and Supplementation: Whys, Whens, and Hows.Endocrine reviews · 2024Article
- Integrating Choosing Wisely, Value-Based Care Principles, Into Undergraduate Medical Education: A Pilot Study.Cureus · 2024Article
- Targeting repetitive laboratory testing with electronic health records-embedded predictive decision support: A pre-implementation study.Clinical biochemistry · 2023Article
- Clinician interest in clinical decision support for PSA-based prostate cancer screening.Urologic oncology · 2023Article
- Factors Associated with Potentially Inappropriate Screening for Vitamin D Deficiency among Women in Medically Underserved Regions of West Texas.Journal of clinical medicine · 2023Article
- Review
- Health, financial and environmental impacts of unnecessary vitamin D testing: a triple bottom line assessment adapted for healthcare.BMJ open · 2022Review
- Article
- Article
- Economic impact of clinical decision support interventions based on electronic health records.BMC health services research · 2020Review
- Impact of a "Chart Closure" Hard Stop Alert on Prescribing for Elevated Blood Pressures Among Patients With Diabetes: Quasi-Experimental Study.JMIR medical informatics · 2020Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
4 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectiveTo 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
methodsWe 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.
resultsVitamin 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.
conclusionSimilar approaches could be used to reduce unnecessary care and decrease costs without reducing quality of care.
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Registered trials
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