Getting hip to vitamin D: A hospitalist project for improving the assessment and treatment of vitamin D deficiency in elderly patients with hip fracture. Issue 11 (5th September 2014)

• Record Type: Journal Article
• Authors: Stephens, John R.; Williams, Christine; Edwards, Eric; Ossman, Paul; DeWalt, Darren A.
• Is Part Of: Journal of hospital medicine. Volume 9:Issue 11(2014)
• Page Start: 714
• Page End: 719
• Publication Date: 2014-09-05
• Subjects: Hospital care -- Periodicals; Clinical medicine -- Periodicals; 610
• DOI: 10.1002/jhm.2255
• Languages: English
• ISSNs: 1553-5592

Abstract

<abstract abstract-type="main"> <title> <x xml:space="preserve">Abstract</x> </title> <sec id="jhm2255-sec-0001" sec-type="section"> <title>BACKGROUND</title> <p>Vitamin D deficiency is common in elderly patients with hip fracture, and clinical practice guidelines recommend screening this population. Our hospitalist group cares for all patients admitted with hip fracture, yet lacked a standardized approach to screening for and treating vitamin D deficiency in this population.</p> </sec> <sec id="jhm2255-sec-0002" sec-type="section"> <title>OBJECTIVES</title> <p>To standardize and improve the assessment and treatment of vitamin D deficiency in elderly patients with hip fracture.</p> </sec> <sec id="jhm2255-sec-0003" sec-type="section"> <title>DESIGN</title> <p>Quality improvement implementation.</p> </sec> <sec id="jhm2255-sec-0004" sec-type="section"> <title>SETTING</title> <p>Tertiary academic hospital.</p> </sec> <sec id="jhm2255-sec-0005" sec-type="section"> <title>PATIENTS</title> <p>Adults age >50 years with hip fracture.</p> </sec> <sec id="jhm2255-sec-0006" sec-type="section"> <title>INTERVENTIONS</title> <p>We implemented a computerized hip fracture order set with preselected orders for 25‐OH vitamin D level and initial supplementation with 1000 IU/day of vitamin D. We presented a review of the literature and performance data to our hospitalist group.</p> </sec> <sec id="jhm2255-sec-0007" sec-type="section"> <title>MEASUREMENTS</title> <p>Percentage of patients with acute hip fracture screened for vitamin D deficiency and percentage of deficient or insufficient patients discharged on recommended dose of vitamin D (50, 000 IU/wk if level <20 ng/mL).</p> </sec> <sec id="jhm2255-sec-0008" sec-type="section"> <title>RESULTS</title> <p>The percentage of patients screened for vitamin D deficiency improved from 37.2% (n = 196) before implementation to 93.5% (n = 107) after (<italic>P</italic> < 0.001). The percentage of deficient or insufficient patients discharged on the recommended vitamin D dose improved from 40.9% to 68.0% (<italic>P</italic> = 0.008). The prevalence of vitamin D deficiency or insufficiency (25‐OH vitamin D level <30 ng/mL) was 50.0%.</p> </sec> <sec id="jhm2255-sec-0009" sec-type="section"> <title>CONCLUSIONS</title> <p>Simple interventions, consisting of a change in computerized order set and presentation of evidence and data from group practice, led to significant improvement in the assessment and treatment of vitamin D deficiency in elderly patients with hip fracture. <italic>Journal of Hospital Medicine</italic> 2014;9:714–719. © 2014 Society of Hospital Medicine</p> </sec> </abstract>