Vitamin D deficiency is common in elderly patients with low‐trauma hip fractures, and major practice guidelines recommend screening for deficiency in this population. Our hospitalist group directly cares for all patients with acute hip fracture, with comanagement by orthopedics. Our hospitalist group did not have a standardized approach to assessment of and treatment for vitamin D deficiency in this population.
To standardize and improve group practice for the assessment of and treatment for vitamin D deficiency in elderly patients with hip fracture.
A task force was formed to review medical evidence, including major practice guidelines, for screening for vitamin D deficiency in elderly patients with low‐trauma hip fracture and to assess our group's adherence to best medical evidence. Review of all hip fracture patients cared for by our group from June 2010 through March 2012 revealed that only 29% had been assessed for vitamin D deficiency. Of those patients who had a level checked, 68% were found to be vitamin D deficient using a cutoff of <30 ng/mL. Of those deficient, 48% were treated with the appropriate dose of vitamin D. Our conclusion was that group performance on this issue was varied and substandard. In October 2012, we created an intervention to address these findings. We presented a review of the medical evidence and data from our group practice at one of the hospitalist group's bimonthly meetings. Concurrently, we altered the hip fracture order set in the hospital computerized physician order entry system to include prechecked boxes for measurement of vitamin D level at admission and for empiric supplementation with 1000 international units of vitamin D pending results. We have received institutional review board approval for a study of the implementation of these changes. Data will be generated by searching the hospital database for ICD‐9 code for femoral neck fracture linked with discharge physicians in our group. Outcome measures will include percentage of patients screened for vitamin D deficiency and percentage of patients discharged on an appropriate dose of vitamin D, both before and after intervention. We will also describe the prevalence of vitamin D deficiency in our population.
Vitamin D deficiency is common in elderly patients with low‐trauma hip fracture. Our hospitalist group practice performance in screening for vitamin D deficiency in this population is varied and as a whole not in adherence with current practice guidelines. With a review of pertinent literature and alteration of the hip fracture computerized physician order entry order set, our group seeks to standardize group practice and improve adherence to practice guidelines