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

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.

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.

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).

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.