title: Getting hip to vitamin D: a hospitalist project for improving the assessment and treatment of vitamin D deficiency in elderly patients with hip fracture.
abstract: BACKGROUND
  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.
  
  
  OBJECTIVE
  To standardize and improve the assessment and treatment of vitamin D deficiency in elderly patients with hip fracture.
  
  
  METHODS
  Quality improvement implementation.
  
  
  METHODS
  Tertiary academic hospital.
  
  
  METHODS
  Adults age >50 years with hip fracture.
  
  
  METHODS
  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.
  
  
  METHODS
  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).
  
  
  RESULTS
  The percentage of patients screened for vitamin D deficiency improved from 37.2% (n = 196) before implementation to 93.5% (n = 107) after (P < 0.001). The percentage of deficient or insufficient patients discharged on the recommended vitamin D dose improved from 40.9% to 68.0% (P = 0.008). The prevalence of vitamin D deficiency or insufficiency (25-OH vitamin D level <30 ng/mL) was 50.0%.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Division of General Medicine and Clinical Epidemiology, University of North Carolina School of Medicine, Chapel Hill, North Carolina.
authors.forename: John R
authors.initials: JR
authors.lastname: Stephens
authors.forename: Christine
authors.initials: C
authors.lastname: Williams
authors.forename: Eric
authors.initials: E
authors.lastname: Edwards
authors.forename: Paul
authors.initials: P
authors.lastname: Ossman
authors.forename: Darren A
authors.initials: DA
authors.lastname: DeWalt
mesh_terms: D000369:Aged, 80 and over; D005260:Female; D006284:Health Plan Implementation / Q000379:methods / Q000706:statistics & numerical data; D006620:Hip Fractures / Q000209:etiology / Q000517:prevention & control*; D020445:Hospitalists / Q000592:standards*; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000379:methods / Q000592:standards / Q000706:statistics & numerical data; D009657:North Carolina / Q000453:epidemiology; D010043:Outcome and Process Assessment, Health Care / Q000706:statistics & numerical data; D015995:Prevalence; D058996:Quality Improvement / Q000458:organization & administration* / Q000592:standards / Q000706:statistics & numerical data; D062606:Tertiary Care Centers / Q000458:organization & administration / Q000592:standards / Q000706:statistics & numerical data; D014807:Vitamin D / Q000008:administration & dosage* / Q000627:therapeutic use; D014808:Vitamin D Deficiency / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy / Q000453:epidemiology
chemical_list: D014807:Vitamin D