Results
Twenty-six patients were evaluated during the initial three months (PDSA #1): 11 patients (42%) with hematological malignancies, 15 patients (58%) with malignant solid tumors, mean age at the time of diagnosis was 8.9 years ±5.4, 10 patients (38%) were males and 16 (62%) females. Only four (15%) patients had baseline Vitamin D testing. Three patients had concentrations that should have required supplementation, but only two (66%) were prescribed the appropriate supplement.
Thirty-three patients were included in the post-intervention group (PDSA #2): 27 patients (88%) with hematological malignancies and six patients (12%) with malignant solid tumors, mean age at the time of diagnosis was 8.6 years ±5.2, 19 patients (57%) were males and 14 (43%) females. Thirty-two (97%) had baseline Vitamin D testing performed. Thirty-three (100%) received appropriate supplementation and completed follow-up testing at the appropriate time (6-8 weeks post-supplementation). Compared to pre-intervention, we tested 27 more patients and identified 10 more patients. From July 2016 to June 2018, over 80% of patients had both baseline Vitamin D testing performed, received appropriate supplementation and completed follow-up testing post-supplementation, demonstrating sustainability over time (Figures 4 and 5). The perceived utility and use survey was completed by 16 out of 24 clinicians and perceived utility of the decision-making tree was 67%, use of decision-making tree reached 83%, and perceived utility of automated triggers was 86%.