Comparison of tWo hospital quality Improvement interventions on potentially inappropriate measurement and SupplEmentation of vitamin D: the WISE-D study

Background

“Not to measure 25(OH)-vitamin D in people without risk factors for vitamin D deficiency” was introduced in the top-5 smarter medicine list of general internal medicine in 2021. The US Preventive Services Task Force and the American Geriatrics Society published similar recommendations. Measuring 25(OH)-vitamin D is indeed rarely useful, because it has little influence on indication for supplementation. However, vitamin D remains frequently measured and supplemented without an appropriate indication. Furthermore, 25(OH)-vitamin D measurement and subsequent supplementation incur significant potentially avoidable costs (CHF 90 million yearly in Switzerland).

Aims

The objective of this project is to test the impact of interventions to implement smarter medicine recommendation on vitamin D deficiency.

Our specifically aims are:

1) To study the frequency of potentially inappropriate measurement and supplementation of vitamin D in older medical inpatients in Switzerland.

2) To compare, in a pre-post intervention study targetting residents and chief residents in general internal medicine, a light vs. an intensive intervention to reduce potentially inappropriate measurement and supplementation of vitamin D in older medical inpatients in Switzerland.

Expected Impact

This project has the potential to reduce the rates of potentially inappropriate measurement and supplementation of vitamin D which incur significant potentially avoidable costs for healthcare systems. Comparing two interventions of different levels of intensity and of different type (active vs. passive) will provide information on whether an intensive active intervention is associated with higher de-implementation rates, compared to a light passive intervention that would be more sustainable and easier to implement. If the approach is successful, it might serve as a model to reduce other low-value practices.