{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,11]],"date-time":"2026-09-11T23:07:17Z","timestamp":1789168037708,"version":"build-2803163510"},"reference-count":21,"publisher":"Wiley","issue":"11","license":[{"start":{"date-parts":[[2021,7,19]],"date-time":"2021-07-19T00:00:00Z","timestamp":1626652800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pediatric Blood &amp; Cancer"],"published-print":{"date-parts":[[2021,11]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>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\u201318\u00a0years with newly diagnosed cancer to \u226580% over 6\u00a0months.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>An inter\u2010professional team reviewed baseline data, then developed and implemented interventions using Plan\u2010Do\u2010Study\u2010Act (PDSA) cycles. Barriers were identified using QI tools, including lack of automated triggers for testing and inconsistent supplementation criteria and follow\u2010up testing post supplementation. Interventions included an institutional vitamin D guideline, clinical decision\u2010making tree for vitamin D deficiency, insufficiency and sufficiency, electronic medical record triggers, and automated testing options.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Baseline: <jats:italic>N<\/jats:italic>\u00a0=\u00a026 patients, four (15%) had baseline vitamin D testing; two (8%) received appropriate supplementation. Postintervention: <jats:italic>N<\/jats:italic>\u00a0=\u00a033 patients; 32 (97%) had baseline vitamin D testing; 33 (100%) received appropriate supplementation and completed follow\u2010up testing timely (6\u20138\u00a0weeks post supplementation). Change was sustained over 24\u00a0months.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>We achieved and sustained our aim for vitamin D testing and supplementation in children with newly diagnosed cancer through inter\u2010professional 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\u2019 vitamin D levels.<\/jats:p><\/jats:sec>","DOI":"10.1002\/pbc.29217","type":"journal-article","created":{"date-parts":[[2021,7,19]],"date-time":"2021-07-19T13:45:31Z","timestamp":1626702331000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Improving vitamin D testing and supplementation in children with newly diagnosed cancer: A quality improvement initiative at Rady Children's Hospital San Diego"],"prefix":"10.1002","volume":"68","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0158-5488","authenticated-orcid":false,"given":"Ksenya","family":"Shliakhtsitsava","sequence":"first","affiliation":[{"name":"Department of Pediatrics, Division of Pediatric Hematology\/Oncology University of California, San Diego\/Rady Children's Hospital San Diego  San Diego California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Erin Stucky","family":"Fisher","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Division of Pediatric Hospital Medicine University of California, San Diego\/Rady Children's Hospital San Diego  San Diego California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Erin M.","family":"Trovillion","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Division of Pediatric Hematology\/Oncology University of California, San Diego\/Rady Children's Hospital San Diego  San Diego California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kelly","family":"Bush","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Division of Pediatric Hematology\/Oncology University of California, San Diego\/Rady Children's Hospital San Diego  San Diego California USA"},{"name":"Quality Improvement Committee, Division of Pediatric Hematology\/Oncology Rady Children's Hospital San Diego  San Diego California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4154-0057","authenticated-orcid":false,"given":"Dennis John","family":"Kuo","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Division of Pediatric Hematology\/Oncology University of California, San Diego\/Rady Children's Hospital San Diego  San Diego California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ron S.","family":"Newfield","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Division of Pediatric Endocrinology University of California San Diego\/Rady Children's Hospital San Diego  San Diego California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5665-8958","authenticated-orcid":false,"given":"Courtney D.","family":"Thornburg","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Division of Pediatric Hematology\/Oncology University of California, San Diego\/Rady Children's Hospital San Diego  San Diego California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"William","family":"Roberts","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Division of Pediatric Hematology\/Oncology University of California, San Diego\/Rady Children's Hospital San Diego  San Diego California USA"},{"name":"Quality Improvement Committee, Division of Pediatric Hematology\/Oncology Rady Children's Hospital San Diego  San Diego California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0588-1532","authenticated-orcid":false,"given":"Paula","family":"Aristizabal","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Division of Pediatric Hematology\/Oncology University of California, San Diego\/Rady Children's Hospital San Diego  San Diego California USA"},{"name":"Quality Improvement Committee, Division of Pediatric Hematology\/Oncology Rady Children's Hospital San Diego  San Diego California USA"},{"name":"Population Sciences, Disparities and Community Engagement University of California San Diego Moores Cancer Center  La Jolla California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2021,7,19]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1210\/jc.2010-2704"},{"key":"e_1_2_10_3_1","unstructured":"Medicine IO. 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