Authors :
Presenting Author: Deepa Sirsi, MD – University of Texas Southwestern Medical Center, Dallas, Texas
Sam Arroyo, BS – Children's Health, Dallas, Texas
Meagan Hainlen, MD – University of Texas Southwestern Medical Center, Dallas, Texas
Janith Mills, PA-C – University of Texas Southwestern Medical Center, Dallas, Texas
Jeremy Fields, RN, BSN, MBA – Children's Health, Dallas, Texas
Afsaneh Talai, MD – University of Texas Southwestern Medical Center, Dallas, Texas
Rationale:
Vitamin D deficiency is associated with adverse health outcomes, including decreased bone mineral density, fatigue, and muscle weakness. Anti-seizure medications have been linked to lower vitamin D levels; however, routine monitoring is often overlooked. A multidisciplinary work group was established at our center to improve vitamin D monitoring through provider education, optimizing workflow during clinic visits, and developing standardized supplementation guidelines. This analysis evaluates whether a formal quality improvement (QI) initiative led to sustained changes in clinical practice for vitamin D screening and intervention. Methods:
A vitamin D QI initiative was implemented at the Children's Medical Center, Dallas from January 1, 2020, to December 31, 2024. A retrospective analysis was performed using Epic electronic health record (EHR) data. Eligible patients were identified using SlicerDicer reporting tools based on predefined inclusion criteria. Criteria included epilepsy diagnosis (ICD-10) and prescription of at least one anti-seizure medication. Rates of vitamin D level collection and Vitamin D levels were assessed over this period.
Results:
A total of 4,588 patients were included in the analysis. A sustained increase in vitamin D monitoring was observed throughout the QI initiative and was sustained subsequently. A linear trendline revealed a positive slope of 0.0582 with an R² value of 0.8226, supporting our hypothesis that Vitamin D deficiency screening increased throughout this initiative. As testing frequency rose, the proportion of patients with deficient (< 20 ug/dl) or insufficient (20-29 ug/dl) vitamin D levels increased compared to those with normal levels, likely indicating increased detection. Conclusions:
This QI initiative effectively improved vitamin D monitoring practices among epilepsy providers through structured education and multidisciplinary collaboration. The sustained increase in testing demonstrates that targeted interventions can lead to meaningful practice changes. Further investigation is needed to determine whether increased monitoring and supplementation improve long-term clinical outcomes in this patient population. Funding: None