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

Abstract

Background Vitamin D deficiency (VDD) is highly prevalent and 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. Objective To evaluate the prevalence of and risk factors for VDD in patients admitted to acute inpatient rehabilitation and to evaluate the efficacy of a standardized vitamin D screening and supplementation protocol. Design Prospective cohort study as part of a quality improvement initiative. Setting An academic, freestanding acute inpatient rehabilitation hospital. Participants Patients consecutively admitted over a 4‐month period between November 2014 and February 2015 (n=128 pre‐intervention and n=129 post‐intervention). Intervention Universal screening of vitamin D level on admission followed by utilization of a standard supplementation protocol. Main Outcome Measures Vitamin D insufficiency (VDI) and VDD prevalence along with screening, and supplementation rates. Results Preintervention, 10.2% of patients were screened for VDD, with 23.1% VDI and 46.2% VDD. Postintervention, 89.9% were screened, with 31.9% VDI and 47.4% VDD. 6.3% of all patients were supplemented on vitamin D preintervention compared to 53.5% postintervention. 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). Conclusions Given the high prevalence of VDD in an acute inpatient rehabilitation hospital, a routine screening and standardized supplementation protocol may improve quality of care. Level of Evidence III