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Improving Vitamin D testing and supplementation in children with newly-diagnosed cancer: A Quality Improvement Initiative at Rady Children’s Hospital San Diego
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  • Ksenya Shliakhtsitsava,
  • Erin Stucky Fisher,
  • Erin Trovillion,
  • Kelly Bush,
  • Dennis Kuo,
  • Ron Newfield,
  • Courtney Thornburg,
  • William Roberts,
  • Paula Aristizabal
Ksenya Shliakhtsitsava
UT Southwestern Medical
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Erin Stucky Fisher
University of California San Diego
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Erin Trovillion
Atrium Health
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Kelly Bush
University of California San Diego
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Dennis Kuo
University of California San Diego School of Medicine
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Ron Newfield
University of California San Diego
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Courtney Thornburg
Rady Children’s Hospital-San Diego
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William Roberts
University of California San Diego
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Paula Aristizabal
Univeristy of California San Diego, Rady Children's Hospital San Diego
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Abstract

Background: Vitamin D deficiency and insufficiency have been associated with poorer health outcomes. Children with cancer are at high risk for Vitamin D deficiency and insufficiency. At our institution, we identified high variability in Vitamin D testing and supplementation in this population. Of those tested, 65% were Vitamin D deficient/insufficient. We conducted a quality improvement (QI) initiative with aim to improve Vitamin D testing and supplementation among children aged 2-18 years old with newly-diagnosed cancer to ≥ 80% over 6 months. Methods: An inter-professional team reviewed baseline data, then developed and implemented interventions using Plan-Do-Study-Act (PDSA) cycles. Barriers were identified using QI tools, including lack of automated triggers for testing and inconsistent supplementation criteria and follow-up testing post-supplementation. Interventions included an institutional Vitamin D guideline, clinical decision-making tree for Vitamin D deficiency, insufficiency and sufficiency, electronic medical record triggers, and automated testing options. Results: Pre-intervention: N=26 patients, four (15%) had baseline Vitamin D testing; two (8%) received appropriate supplementation. Post-intervention: N=33 patients; 32 (97%) had baseline Vitamin D testing; 33 (100%) received appropriate supplementation and completed follow-up testing timely (6-8 weeks post-supplementation). Change was sustained over 24 months. Conclusions: We achieved and sustained our aim for Vitamin D testing and supplementation in children with newly-diagnosed cancer through inter-professional collaboration of hematology/oncology, endocrinology, hospital medicine, pharmacy, nursing, and information technology. Future PDSA cycles will address patient compliance with Vitamin D supplementation and impact on patients’ Vitamin D levels.

Peer review status:ACCEPTED

11 Jan 2021Submission Checks Completed
11 Jan 2021Assigned to Editor
11 Jan 2021Submitted to Pediatric Blood & Cancer
12 Jan 2021Reviewer(s) Assigned
12 Feb 2021Review(s) Completed, Editorial Evaluation Pending
12 Feb 2021Editorial Decision: Revise Major
05 May 20211st Revision Received
05 May 2021Assigned to Editor
05 May 2021Submission Checks Completed
06 May 2021Reviewer(s) Assigned
24 May 2021Review(s) Completed, Editorial Evaluation Pending
25 May 2021Editorial Decision: Revise Minor
14 Jun 2021Assigned to Editor
14 Jun 20212nd Revision Received
14 Jun 2021Submission Checks Completed
17 Jun 2021Review(s) Completed, Editorial Evaluation Pending
17 Jun 2021Editorial Decision: Accept