Translating evidence into action: An intervention for increasing vitamin D supplementation in a deficient rehabilitation population

Abstract

Introduction/Background Inadequate vitamin D is highly prevalent, affecting approximately 42-77% of the general United States population. Vitamin D deficiency (VDD) increases the risk of osteoporosis, falls, and fractures. Acute inpatient rehabilitation patients have several risk factors for VDD, and the adverse effects of VDD may hinder long-term functional gain. Material and method Prospective cohort study, evaluating patients admitted before and after a screening intervention as part of a quality improvement initiative at an academic, freestanding acute inpatient rehabilitation hospital. This study included a convenience sample of patients admitted two months pre-intervention (n = 128), and patients admitted two months post-intervention (n = 129). Providers obtained a routine serum vitamin D level on admission (universal screening), then utilized a standard supplementation protocol. Vitamin D insufficiency (VDI) was defined as a 25-hydroxyvitamin D (25(OH)D) level of 20–29.9 ng/mL, and VDD as Results Pre-intervention, 10.2% of patients were screened for VDD, with 23.1% found to be VDI and 46.2% VDD. Post-intervention, 89.9% of patients were screened, with 31.9% found to be VDI and 47.4% VDD. Pre-intervention, 88.9% of all screened patients were on vitamin D supplementation at discharge versus 75.0% post-intervention. In both uni- and multivariate analyses, we found increased risk of VDD was significantly associated with African American race (OR 7.3, 95% CI, 1.56–34.2, P = 0.12) and age younger than 65 (OR 13.6, 95% CI, 2.5–73.8, P = 0.002). Diagnoses in the “other neurologic” category were associated with decreased risk of VDD (OR 0.01, 95% CI, 0.001–0.193, P = 0.002). Conclusion Given the high prevalence of VDD in an acute inpatient rehabilitation hospital, a routine screening and standardized supplementation protocol may be a good practice to improve quality of care.