Non-interruptive decision support to increase appropriate screening for primary hyperparathyroidism.

OBJECTIVE

Primary hyperparathyroidism (PHPT) affects 1% of adults, but fewer than one-third of screen-eligible patients are tested. We developed and evaluated two new non-interruptive, clinician-facing alerts to increase appropriate PHPT screening.

MATERIALS AND

METHODS

We designed process changes to facilitate guideline-informed patient identification via electronic phenotyping, laboratory test ordering, result interpretation, and follow-up. The computable phenotype was retrospectively validated. Clinician-facing alerts were built atop existing workflows for health maintenance (HM) and pended orders (PO) and evaluated in separate primary care clinics.

RESULTS

Screening laboratory orders were more frequent in PO (81%; n = 30/37; p < 0.001) and HM (57%; n = 51/90; p < 0.001) than in control (19%; n = 373/1945) clinics. Increased screening appeared to yield higher detection of likely PHPT in PO (43%; 16/37; p < 0.001) and HM (8%; 7/90; p = 0.01) than in control (2%; 48/1945) clinics.

CONCLUSION

Non-interruptive alerts demonstrate potential to substantially increase PHPT screening among appropriate patients.