Naugler Christopher, Hemmelgarn Brenda, Quan Hude, Clement Fiona, Sajobi Tolulope, Thomas Roger, Turin Tanvir C, Hnydyk William, Chin Alex, Wesenberg James
Departments of Pathology and Laboratory Medicine (Naugler, Chin), Family Medicine (Naugler, Thomas, Turin), Community Health Sciences (Hemmelgarn, Quan, Clement, Sajobi), Cumming School of Medicine, University of Calgary, Calgary, Alta; Alberta Medical Association (Hnydyk), Edmonton, Alta; Red Deer Regional Hospital Centre (Wesenberg), Clinical Laboratory, Red Deer, Alta.
CMAJ Open. 2017 Jan 17;5(1):E36-E39. doi: 10.9778/cmajo.20160073. eCollection 2017 Jan-Mar.
We describe the implementation of an intervention in Alberta in support of the Choosing Wisely Canada recommendation against population screening for vitamin D deficiency (as determined by serum total 25-hydroxyvitamin D testing). We hypothesized that the introduction of a specialized requisition for vitamin D testing would reduce the annual number of vitamin D tests performed.
We performed a cross-sectional observational study that included all vitamin D tests ordered in Alberta between Apr. 1, 2015, and Mar. 31, 2016. There were no exclusion criteria. A special requisition for ordering vitamin D tests in Alberta was introduced on Apr. 1, 2015. Using an interrupted time series model, we compared predicted versus observed vitamin D test volumes for the 12-month period following the introduction of the new requisition. The sole outcome measure was the monthly change in volume of vitamin D testing. In addition, we calculated any cost savings as a result of reduced testing.
Over the first 12 months of the intervention, there was a reduction in the number of tests ordered from a predicted 342 477 tests to 29 525 tests (91.4% reduction). This decrease represented a direct spending decrease of Can$938 856-$1 564 760 per year in Alberta.
A provincially led implementation of a Choosing Wisely Canada recommendation resulted in a large and sustained reduction in serum total 25-hydroxyvitamin D testing in Alberta. This study shows that provincially led interventions based on Choosing Wisely Canada recommendations can result in substantial reductions in laboratory tests.
我们描述了在艾伯塔省实施的一项干预措施，以支持加拿大明智选择运动关于反对对维生素D缺乏进行人群筛查的建议（通过血清总25-羟基维生素D检测来确定）。我们假设引入专门的维生素D检测申请单会减少每年进行的维生素D检测数量。
我们进行了一项横断面观察性研究，纳入了2015年4月1日至2016年3月31日期间在艾伯塔省开具的所有维生素D检测订单。没有排除标准。2015年4月1日在艾伯塔省引入了一种用于订购维生素D检测的特殊申请单。使用中断时间序列模型，我们比较了新申请单引入后12个月期间维生素D检测量的预测值与观察值。唯一的结果指标是维生素D检测量的月度变化。此外，我们计算了因检测减少而节省的成本。
在干预的前12个月，检测订单数量从预测的342477次减少到29525次（减少了91.4%）。这一减少意味着艾伯塔省每年直接支出减少938856加元至1564760加元。
由省级主导实施加拿大明智选择运动的一项建议，导致艾伯塔省血清总25-羟基维生素D检测大幅且持续减少。这项研究表明，基于加拿大明智选择运动建议的省级主导干预措施可大幅减少实验室检测。
