Intervention for Increasing Vitamin D Supplementation in a Deficient Rehabilitation Population: Outcomes of a Quality Improvement Initiative

Krull C1, Benjamin A1, Mairin J1, Principe J1, Cai Q2, Tailor Y1.

PM R. 2019 Jan 27. doi: 10.1002/pmrj.12092. [Epub ahead of print]

Inadequate vitamin D is highly prevalent. Vitamin D deficiency (VDD) increases the risk of osteoporosis, falls, and fractures. Patients in acute inpatient rehabilitation have several risk factors for VDD, the adverse effects of which may hinder long-term functional gain.

To evaluate the prevalence of and risk factors for VDD in patients admitted to acute inpatient rehabilitation along with the efficacy of a standardized vitamin D screening and supplementation protocol.

Prospective cohort study as part of a quality improvement initiative.

An academic, freestanding acute inpatient rehabilitation hospital.

257 patients consecutively admitted.

Universal screening of vitamin D level on admission followed by utilization of a standard supplementation protocol.

Vitamin D insufficiency (VDI) and VDD prevalence along with screening, and supplementation rates.

Pre-intervention, 10.2% of patients were screened for VDD, with 23.1% VDI and 46.2% VDD. Post-intervention, 89.9% were screened, with 31.9% VDI and 47.4% VDD. 6.3% of all patients were supplemented on vitamin D pre-intervention compared to 53.5% post-intervention. In multivariate analyses, the odds of VDD was significantly associated with African American race (OR 7.30, 95% CI, 1.56-34.20, p=.12) and age younger than 65 (OR 13.62 95% CI, 2.51-73.83, p=.002). Diagnoses in the “other neurologic” category were associated with decreased odds of VDD (OR 0.01, 95% CI, 0.001-0.193, p=.002).

Given the high prevalence of VDD in an acute inpatient rehabilitation hospital, a routine screening and standardized supplementation protocol may improve quality of care.


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