title: Implementation of an intervention to reduce population-based screening for vitamin D deficiency: a cross-sectional study.
abstract: BACKGROUND
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: 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.
authors.forename: Christopher
authors.initials: C
authors.lastname: Naugler
authors.affiliation: 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.
authors.forename: Brenda
authors.initials: B
authors.lastname: Hemmelgarn
authors.affiliation: 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.
authors.forename: Hude
authors.initials: H
authors.lastname: Quan
authors.affiliation: 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.
authors.forename: Fiona
authors.initials: F
authors.lastname: Clement
authors.affiliation: 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.
authors.forename: Tolulope
authors.initials: T
authors.lastname: Sajobi
authors.affiliation: 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.
authors.forename: Roger
authors.initials: R
authors.lastname: Thomas
authors.affiliation: 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.
authors.forename: Tanvir C
authors.initials: TC
authors.lastname: Turin
authors.affiliation: 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.
authors.forename: William
authors.initials: W
authors.lastname: Hnydyk
authors.affiliation: 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.
authors.forename: Alex
authors.initials: A
authors.lastname: Chin
authors.affiliation: 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.
authors.forename: James
authors.initials: J
authors.lastname: Wesenberg