{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T21:26:26Z","timestamp":1791926786542,"version":"4.3.4"},"reference-count":70,"publisher":"American Medical Association (AMA)","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Intern Med"],"published-print":{"date-parts":[[2024,2,1]]},"abstract":"<jats:sec id=\"ab-ioi230088-4\"><jats:title>Importance<\/jats:title><jats:p>Primary aldosteronism (PA) is a common cause of secondary hypertension and an independent risk factor for cardiovascular morbidity and mortality. Fewer than 2% to 4% of patients at risk are evaluated for PA.<\/jats:p><\/jats:sec><jats:sec id=\"ab-ioi230088-5\"><jats:title>Objective<\/jats:title><jats:p>To develop and evaluate an electronic health record best-practice advisory (BPA) that assists with PA screening.<\/jats:p><\/jats:sec><jats:sec id=\"ab-ioi230088-6\"><jats:title>Design, Setting, and Participants<\/jats:title><jats:p>This prospective quality improvement study was conducted at academic center outpatient clinics. Data analysis was performed between February and June 2023 and included adults with hypertension and at least 1 of the following: 4 or more current antihypertensive medications; hypokalemia; age younger than  35 years; or adrenal nodule(s). Patients previously tested for PA were excluded.<\/jats:p><\/jats:sec><jats:sec id=\"ab-ioi230088-7\"><jats:title>Exposure<\/jats:title><jats:p>A noninterruptive BPA was developed to trigger for PA screening candidates seen in outpatient setting by clinicians who treat hypertension. The BPA included an order set for PA screening and a link to results interpretation guidance.<\/jats:p><\/jats:sec><jats:sec id=\"ab-ioi230088-8\"><jats:title>Main Outcomes and Measures<\/jats:title><jats:p>(1) The number of PA screening candidates identified by the BPA between October 1, 2021, and December 31, 2022; (2) the rates of PA screening; and (3) the BPA use patterns, stratified by physician specialty were assessed.<\/jats:p><\/jats:sec><jats:sec id=\"ab-ioi230088-9\"><jats:title>Results<\/jats:title><jats:p>Over 15 months, the BPA identified 14\u202f603 unique candidates (mean [SD] age, 65.5 [16.9] years; 7300 women [49.9%]; 371 [2.5%] Asian, 2383 [16.3%] Black, and 11\u202f225 [76.9%] White individuals) for PA screening, including 7028 (48.1%) with treatment-resistant hypertension, 6351 (43.5%) with hypokalemia, 1537 (10.5%) younger than 35 years, and 445 (3.1%) with adrenal nodule(s). In total, 2040 patients (14.0%) received orders for PA screening. Of these, 1439 patients (70.5%) completed the recommended screening within the system, and 250 (17.4%) had positive screening results. Most screening orders were placed by internists (40.0%) and family medicine physicians (28.1%). Family practitioners (80.3%) and internists (68.9%) placed most orders via the embedded order set, while specialists placed most orders (83.0%-95.4%) outside the BPA. Patients who received screening were younger and included more women and Black patients than those not screened. The likelihood of screening was higher among patients with obesity and dyslipidemia and lower in those with chronic kidney disease and established cardiovascular complications.<\/jats:p><\/jats:sec><jats:sec id=\"ab-ioi230088-10\"><jats:title>Conclusions and Relevance<\/jats:title><jats:p>The study results suggest that noninterruptive BPAs are potentially promising PA screening-assistance tools, particularly among primary care physicians. Combined with artificial intelligence algorithms that optimize the detection yield, refined BPAs may contribute to personalized hypertension care.<\/jats:p><\/jats:sec>","DOI":"10.1001\/jamainternmed.2023.7389","type":"journal-article","created":{"date-parts":[[2024,1,8]],"date-time":"2024-01-08T16:01:00Z","timestamp":1704729660000},"page":"174","source":"Crossref","is-referenced-by-count":30,"title":["Evaluation of a Best-Practice Advisory for Primary Aldosteronism Screening"],"prefix":"10.1001","volume":"184","author":[{"given":"Suranut","family":"Charoensri","sequence":"first","affiliation":[{"name":"Division of Metabolism, Endocrinology, and Diabetes, Department of Internal Medicine, University of Michigan, Ann Arbor"},{"name":"Division of Endocrinology and Metabolism, Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Linda","family":"Bashaw","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, University of Michigan, Ann Arbor"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cheryl","family":"Dehmlow","sequence":"additional","affiliation":[{"name":"Health Information and Technology Systems, University of Michigan, Ann Arbor"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tammy","family":"Ellies","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, University of Michigan, Ann Arbor"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jennifer","family":"Wyckoff","sequence":"additional","affiliation":[{"name":"Division of Metabolism, Endocrinology, and Diabetes, Department of Internal Medicine, University of Michigan, Ann Arbor"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adina F.","family":"Turcu","sequence":"additional","affiliation":[{"name":"Division of Metabolism, Endocrinology, and Diabetes, Department of Internal Medicine, University of Michigan, Ann Arbor"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"10","reference":[{"issue":"11","key":"ioi230088r1","doi-asserted-by":"publisher","first-page":"665","DOI":"10.1038\/s41574-022-00730-2","article-title":"Primary aldosteronism\u2014a multidimensional syndrome.","volume":"18","author":"Turcu","year":"2022","journal-title":"Nat Rev Endocrinol"},{"issue":"5","key":"ioi230088r2","doi-asserted-by":"publisher","first-page":"1889","DOI":"10.1210\/jc.2015-4061","article-title":"The management of primary aldosteronism: case detection, diagnosis, and treatment: an Endocrine Society clinical practice guideline.","volume":"101","author":"Funder","year":"2016","journal-title":"J Clin Endocrinol 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