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Cited by 20Healthcare cost, quality, practicesVitamin D Research StudiesClinical Laboratory Practices and Quality Control

Patterns of Clinical Care Subsequent to Nonindicated Vitamin D Testing in Primary Care

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Rockwell, Michelle S., Wu, YingXing, Salamoun, Mariana, Hulver, Matthew W., Epling, John W.·2020·The Journal of the American Board of Family Medicine
DOI 10.3122/jabfm.2020.04.200007
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Abstract

BACKGROUND: Exponential increases in nonindicated, low-value vitamin D testing have been reported over the past 15 years. Downstream effects of such testing have not been well quantified. METHODS: The purpose of this study was to describe patterns of vitamin D testing within primary care of a large regional health system and to explore downstream health service utilization subsequent to nonindicated testing. Instances of vitamin D testing in 2015 were obtained by an electronic health record-automated search. A subset of patients for whom vitamin D testing was classified as nonindicated was identified, and vitamin D-related service utilization was tracked for 24 months. RESULTS: Of the 77,836 adult primary care patient records identified in 2015, vitamin D tests were conducted on 8,042 (10.3%), with 24.3% of tests yielding abnormal results. In the nonindicated test subset (n = 574), substantial clinical variability was illustrated by 85 care pathways and 26 vitamin D prescriptions. Forty-five percent of abnormal vitamin D lab tests were not followed up with repeat vitamin D tests. Vitamin D-related services (laboratory tests, imaging, and prescriptions) occurred at an average rate of 1.6 services per patient during the 24 months following nonindicated vitamin D testing. Some of these services were also classified as nonindicated. CONCLUSIONS: Evidence of a health service cascade following nonindicated vitamin D testing exists. Opportunities for improved consistency and quality of care related to vitamin D were observed in our health system. These results may inform clinical pathways related the prevention, evaluation, and treatment of low vitamin D.

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  • Detecting and treating mild vitamin D deficiencies has minimal impact on symptoms or overall health outcomes but can lead to unnecessary testing and increased costs.

    “Research shows that detecting and treating mild deficiencies has a minimal impact on symptoms or overall health outcomes but can lead to unnecessary testing and increased costs [138].”

    From Toward Safer Diagnoses: A SEIPS-Based Narrative Review of Diagnostic Errors (2026) · cites this paper as [138]

    The Introduction and Patterns of Care sections describe nonindicated vitamin D testing as low-value care that can generate follow-up tests and substantial costs. But Patterns of Care says it is unclear whether identifying and treating low vitamin D benefits patients without specific indications; it does not establish that treating mild deficiencies has minimal impact on symptoms or overall health outcomes. Page numbers were not available in our copy. (LLM, conf=0.88)

    Experimental — accuracy not yet measured

  • Applying specific diagnostic tests to the general population with constitutional symptoms can result in low-value outcomes.

    “Furthermore, applying specific diagnostic tests to the general population with constitutional symptoms can result in low-value outcomes.”

    From Toward Safer Diagnoses: A SEIPS-Based Narrative Review of Diagnostic Errors (2026) · cites this paper as [138]

    The Patterns of Care section reports that some services following nonindicated vitamin D tests were themselves low value; fatigue was a common diagnosis associated with those tests. This supports the concern about testing patients with nonspecific symptoms, but the study examined vitamin D testing in primary care, not specific diagnostic tests generally or the general population. (LLM, conf=0.85)

    Experimental — accuracy not yet measured

  • Vitamin D screening is often ordered for patients with general symptoms like fatigue or vague pain rather than those who are actually at risk.

    “However, it is often ordered for patients with general symptoms like fatigue or vague pain, rather than those who are actually at risk.”

    From Toward Safer Diagnoses: A SEIPS-Based Narrative Review of Diagnostic Errors (2026) · cites this paper as [138]

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Authors
Rockwell, M. S., Wu, Y., Salamoun, M., Hulver, M. W., & Epling, J. W.
Affiliations
Carilion Clinic (US)
ORCID
Venue
The Journal of the American Board of Family Medicine
Publisher
American Board of Family Medicine (ABFM)
Published
2020-07
Volume
33
Issue
4
Pages
569-579
ISSN
  • 1557-2625 (ISSN-L)
  • 1558-7118
DOI
10.3122/jabfm.2020.04.200007
OpenAlex
W3042360459
Cited by
20
References
46
Citations by year
2026: 2 · 2024: 1 · 2023: 5 · 2022: 7 · 2021: 3 · 2020: 2
FWCI
4.43
Type
journal article
Language
en
Open access
Locations
  • The Journal of the American Board of Family Medicine (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Health Professions › General Health Professions › Healthcare cost, quality, practices
  • Health Sciences › Medicine › Pathology and Forensic Medicine › Vitamin D Research Studies
  • Health Sciences › Medicine › Physiology › Clinical Laboratory Practices and Quality Control
Keywords
vitamin D testing, low-value care, laboratory abnormalities, primary care, care pathways, quality of care
MeSH terms
Adult, Diagnostic Tests, Routine, Humans, Primary Health Care, Vitamin D, Vitamin D Deficiency

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