Is the Climb Worth the View? The Savings/Alert Ratio for Reducing Vitamin D Testing

Chase D. Hendrickson; Michael F. McLemore; Kathryn M. Dahir; Shari Just; Zahra Shajani-Yi; Joseph LeGrand; Christoph U. Lehmann; Asli Weitkamp

doi:10.1055/s-0040-1701678

Applied Clinical Informatics, Table of Contents

Appl Clin Inform 2020; 11(01): 160-165
DOI: 10.1055/s-0040-1701678

Research Article

Georg Thieme Verlag KG Stuttgart · New York

Is the Climb Worth the View? The Savings/Alert Ratio for Reducing Vitamin D Testing

Authors

Chase D. Hendrickson

¹Division of Diabetes, Endocrinology, and Metabolism, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, United States
Michael F. McLemore

²Health Information Technology, Vanderbilt University Medical Center, Nashville, Tennessee, United States
Kathryn M. Dahir

¹Division of Diabetes, Endocrinology, and Metabolism, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, United States
Shari Just

²Health Information Technology, Vanderbilt University Medical Center, Nashville, Tennessee, United States
Zahra Shajani-Yi

³Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee, United States
Joseph LeGrand

²Health Information Technology, Vanderbilt University Medical Center, Nashville, Tennessee, United States
Christoph U. Lehmann

⁴Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee, United States
Asli Weitkamp

²Health Information Technology, Vanderbilt University Medical Center, Nashville, Tennessee, United States

⁴Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee, United States

Abstract

Background Despite guideline recommendations, vitamin D testing has increased substantially. Clinical decision support (CDS) presents an opportunity to reduce inappropriate laboratory testing.

Objectives and Methods To reduce inappropriate testing of vitamin D at the Vanderbilt University Medical Center, a CDS assigned providers to receive or not receive an electronic alert each time a 25-hydroxyvitamin D assay was ordered for an adult patient unless the order was associated with a diagnosis in the patient's chart for which vitamin D testing is recommended. The CDS ran for 80 days, collecting data on number of tests, provider information, and basic patient demographics.

Results During the 80 days, providers placed 12,368 orders for 25-hydroxyvitamin D. The intervention group ordered a vitamin D assay and received the alert for potentially inappropriate testing 2,181 times and completed the 25-hydroxyvitamin D order in 89.9% of encounters, while the control group ordered a vitamin D assay (without receiving an alert) 2,032 times and completed the order in 98.1% of encounters, for an absolute reduction of testing of 8% (p < 0.001).

Conclusion This CDS reduced vitamin D ordering by utilizing a soft-stop approach. At a charge of $179.00 per test and a cost to the laboratory of $4.20 per test, each display of the alert led to an average reduction of $14.70 in charges and of $0.34 in spending by the laboratory (the savings/alert ratio). By describing the effectiveness of an electronic alert in terms of the savings/alert ratio, the impact of this intervention can be better appreciated and compared with other interventions.

Keywords

clinical decision support alerting - order entry - quality improvement - clinical practice guidelines - ambulatory care

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References

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