Use of a Best Practice Advisory to increase the detection rate of hyperparathyroidism

Abstract

Background: Timely diagnosis and treatment of primary hyperparathyroidism requires a high index of suspicion and collaboration across specialties. The diagnosis often is overlooked. This study aimed to determine whether the introduction of a screening algorithm for primary hyperparathyroidism would increase diagnosis and treatment rates. Methods: An electronic health record Best Practice Advisory was launched in 2022, encouraging parathyroid hormone testing for patients with hypercalcemia (calcium ≥11 mg/dL). Parathyroid hormone testing, specialist referrals, and parathyroidectomy were examined pre- and postintervention. Results: There were 902 and 893 patients with hypercalcemia in the pre- and postintervention groups, respectively. Parathyroid hormone testing increased from 24.61% to 38.75% after the Best Practice Advisory was implemented (P < .01). Specialist referrals and rates of parathyroidectomy were unchanged between the pre- and postintervention groups (referrals in 41.44% vs 41.04% of those with parathyroid hormone testing, P = .93; parathyroidectomy in 27.17% vs 26.76% of those referred, P = 1.00). Parathyroid hormone testing was performed more commonly in older patients (69.63 vs 59.01 years, P < .01). Patients referred to a specialist were younger (67.59 vs 71.05 years, P = .04). Patients with primary hyperparathyroidism–associated comorbidities were more likely to undergo parathyroid hormone testing, with no differences in rates of specialist referrals (P = .11) or parathyroidectomy (P = .60). Conclusion: An electronic health record Best Practice Advisory was effective in increasing primary hyperparathyroidism screening, but did not result in a higher rate of specialist referrals or parathyroidectomies. Reflex parathyroid hormone testing as well as increased education about primary hyperparathyroidism may further improve screening, referrals, and treatment.