{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T18:46:25Z","timestamp":1792003585709,"version":"4.4.0"},"reference-count":45,"publisher":"BMJ","issue":"2","license":[{"start":{"date-parts":[[2024,2,28]],"date-time":"2024-02-28T00:00:00Z","timestamp":1709078400000},"content-version":"unspecified","delay-in-days":27,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001826","name":"ZonMw","doi-asserted-by":"publisher","award":["839205002"],"award-info":[{"award-number":["839205002"]}],"id":[{"id":"10.13039\/501100001826","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2024,2,15]]},"published-print":{"date-parts":[[2024,2]]},"abstract":"\n Objectives<\/jats:title>\n \n To assess the extent of non-indicated vitamin B\n 12<\/jats:sub>\n - and D-testing among Dutch clinicians and its variation among hospitals.\n <\/jats:p>\n <\/jats:sec>\n \n Design<\/jats:title>\n Cross-sectional study using registration data from 2015 to 2019.<\/jats:p>\n <\/jats:sec>\n \n Participants<\/jats:title>\n \n Patients aged between 18 and 70 years who received a vitamin B\n 12<\/jats:sub>\n - or D-test.\n <\/jats:p>\n <\/jats:sec>\n \n Primary and secondary outcome measures<\/jats:title>\n \n The proportion of non-indicated vitamin B\n 12<\/jats:sub>\n - and D-testing among Dutch clinicians and its variation between hospitals (n=68) over 2015\u20132019.\n <\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n Between 2015 and 2019, at least 79.0% of all vitamin B\n 12<\/jats:sub>\n -tests and 82.0% of vitamin D-tests lacked a clear indication. The number of vitamin B\n 12<\/jats:sub>\n -tests increased by 2.0% over the examined period, while the number of D-tests increased by 12.2%. The proportion of the unexplained variation in non-indicated vitamin B\n 12<\/jats:sub>\n - and D-tests that can be ascribed to differences between hospitals remained low. Intraclass correlation coefficients ranged between 0.072 and 0.085 and 0.081 and 0.096 for non-indicated vitamin B\n 12<\/jats:sub>\n - and D-tests, respectively. The included casemix variables patient age, gender, socioeconomic status and hospital size only accounted for a small part of the unexplained variation in non-indicated testing. Additionally, a significant correlation was observed in non-indicated vitamin B\n 12<\/jats:sub>\n - and D-testing among the included hospitals.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusion<\/jats:title>\n \n Hospital clinicians order vitamin B\n 12<\/jats:sub>\n - and D-tests without a clear indication on a large scale. Only a small proportion of the unexplained variation could be attributed to differences between hospitals.\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1136\/bmjopen-2023-075241","type":"journal-article","created":{"date-parts":[[2024,2,28]],"date-time":"2024-02-28T22:02:37Z","timestamp":1709157757000},"page":"e075241","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":2,"title":["Non-indicated vitamin B\n 12<\/sub>\n - and D-testing among Dutch hospital clinicians: a cross-sectional analysis in data registries"],"prefix":"10.1136","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9440-7703","authenticated-orcid":false,"given":"Joris LJM","family":"M\u00fcskens","sequence":"first","affiliation":[{"name":"IQ Health science department, Radboud University Medical Centre, Nijmegen, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3134-487X","authenticated-orcid":false,"given":"Rudolf Bertijn","family":"Kool","sequence":"additional","affiliation":[{"name":"IQ Health science department, Radboud University Medical Centre, Nijmegen, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gert P","family":"Westert","sequence":"additional","affiliation":[{"name":"IQ Health science department, Radboud University Medical Centre, Nijmegen, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maarten","family":"Zaal","sequence":"additional","affiliation":[{"name":"Dutch Hospital Data, Utrecht, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hein","family":"Muller","sequence":"additional","affiliation":[{"name":"Dutch Hospital Data, Utrecht, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5944-2431","authenticated-orcid":false,"given":"Femke","family":"Atsma","sequence":"additional","affiliation":[{"name":"IQ Health science department, Radboud University Medical Centre, Nijmegen, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4003-8540","authenticated-orcid":false,"given":"S A","family":"van Dulmen","sequence":"additional","affiliation":[{"name":"IQ Health science department, Radboud University Medical Centre, Nijmegen, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2024,2,28]]},"reference":[{"key":"2025120519311034000_14.2.e075241.1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjqs-2020-012576"},{"key":"2025120519311034000_14.2.e075241.2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(16)32585-5"},{"key":"2025120519311034000_14.2.e075241.3","doi-asserted-by":"publisher","DOI":"10.1177\/1077558716656970"},{"key":"2025120519311034000_14.2.e075241.4","doi-asserted-by":"crossref","first-page":"179","DOI":"10.5694\/mja14.01664","article-title":"In search of professional consensus in defining and reducing low-value care","volume":"203","author":"Scott","year":"2015","journal-title":"Med J Aust"},{"key":"2025120519311034000_14.2.e075241.5","doi-asserted-by":"crossref","DOI":"10.1186\/s12913-020-05956-2","article-title":"Potentially inappropriate testing for vitamin D deficiency: a cross-sectional study in Switzerland","volume":"20","author":"Essig","year":"2020","journal-title":"BMC Health Serv Res"},{"key":"2025120519311034000_14.2.e075241.6","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2018-028355","article-title":"Trends in the incidence of testing for vitamin D deficiency in primary care in the UK","volume":"9","author":"Crowe","year":"2019","journal-title":"BMJ Open"},{"key":"2025120519311034000_14.2.e075241.7","doi-asserted-by":"crossref","first-page":"654","DOI":"10.1111\/jep.12696","article-title":"Three-year analysis of repeated laboratory tests for the markers total cholesterol, Ferritin, vitamin D, vitamin B(12), and folate, in a large research and teaching hospital in Italy","volume":"23","author":"Lanzoni","year":"2017","journal-title":"J Eval Clin Pract"},{"key":"2025120519311034000_14.2.e075241.8","doi-asserted-by":"crossref","DOI":"10.1136\/bmj.k4666","article-title":"Temporal trends in use of tests in UK primary care, 2000-15: retrospective analysis of 250 million tests","volume":"363","author":"O\u2019Sullivan","year":"2018","journal-title":"BMJ"},{"key":"2025120519311034000_14.2.e075241.9","unstructured":"American Society for Clinical Pathology . 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