| Sumario: | Significance & Background: Patients undergoing hematopoietic stem cell transplant (HSCT) have a high risk for vitamin D deficiency prior to and post trans-plantation as compared to the general population. The increasing prevalence in vitamin D deficiency among patients with HSCT may lead to post-transplant com-plications, which significantly affect duration and quality of life among this population. Despite the importance of vitamin D, transplant Advanced Practice Provider (APP) underperform screening of vitamin D level and replacement therapy nationwide. Purpose: In this quality improvement (QI) project, the author aims at establishing the application of evidence based systematic vitamin D algorithm for transplant APP to provide consistent practice in vitamin D screening/replacement therapy for patients with HSCT. Interventions: The QI project utilizes observational cohort design at an APP-run outpatient HSCT clinic in an urban city of Southern California. The intervention includes an educational session regarding the importance of vitamin D supplementation and use of newly developed vitamin D algorithm for monitoring/supplementation. The effectiveness of intervention is evaluated by 1) the number of vitamin D serum test orders, and 2) the number/proportion of patients received vitamin D replacement therapy based on the algorithm at pre-transplant and 6 weeks post initial treatment. The author analyzes the data with a one-tailed t-test with a p-value of 0.05% (considered as statistically significant). Results: After the educational sessions, the compliance of ordering vitamin D serum leveled per national standards based on a new algorithm, and 50 % of patients initiated supple-mentation for levels below 30 ng/ml. At 6 weeks post initial implementation, the APP repeated the vitamin D serum level for 80% of patients. Discussion: Overall, this project was successful in showing the efficacy of an APP educational session as indicated by statistically significant improvements and clinically significance in the rate of screening and replacement therapy. Using a clear guideline based on vitamin D algorithm, APP holds potential to provide consistent high quality and cost effective care for this vulnerable population. Future rigorous studies, such as a randomized control trial to evaluate long term efficacy of vitamin D therapy, are recommended to strengthen the evidence of this practice and assist further dissemination.
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