# Understanding Reasons for Underdiagnosis and Undertreatment of Primary Hyperparathyroidism in the VA

> **NIH VA I21** · MICHAEL E DEBAKEY VA MEDICAL CENTER · 2024 · —

## Abstract

Background: Primary hyperparathyroidism (pHPT) is a common endocrine disorder, whose incidence has
been increasing over time. Untreated pHPT can lead to many preventable complications (nephrolithiasis,
osteoporosis and pathologic fractures, neuropsychiatric and cognitive disorders) and significantly decrease the
quality of life. Our preliminary work with national data from the Veterans Affairs (VA) Corporate Data
Warehouse (CDW) has identified significant under-recognition of pHPT among hypercalcemic patients and
underutilization of indicated parathyroidectomy across the VA healthcare system. To design effective
interventions, we first need to validate the database-derived results with data from individual medical record
review, and to explore the reasons for such a significant deviation from evidence-based guidelines. We also
need to uncover possible misconceptions and gaps in knowledge among clinicians, possible system barriers in
the management of patients with pHPT, as well as to elicit input from clinicians about possible interventions.
Innovation: This is the first study to explore at a granular level with a mixed methods approach the reasons for
the under-recognition and undertreatment of pHPT observed both in the VA and in other healthcare systems.
We anticipate that this pilot work will serve as the basis for health-informatics-based interventions, which will
be some of the first ones addressing surgical diseases, and thus provide a model for other surgical pathologies
in the future. The proposal intends to address two VA HSR&D areas of emphasis: Information systems to
enhance access and timeliness to care (informatics to facilitate diagnosis and management of a common
endocrine disease) and Innovation in Health Services Research (novel approach of broadening the focus of
Health Informatics in the management of surgical diseases across the VA system).
Specific aims: (1) To evaluate the underlying reasons for underdiagnosis and undertreatment of patients with
pHPT in the VA; (2) To explore VA clinician perceptions related to diagnosis and management of
hypercalcemia and pHPT, including their attitudes towards potential interventions for improvement.
Methodology: In this exploratory pilot project, we will conduct an in-depth medical record review of 200
hypercalcemic Veterans without parathyroid hormone testing (underdiagnosis) and of 200 patients with pHPT
without parathyroidectomy (undertreatment) to explore possible reasons for underdiagnosis and
undertreatment of pHPT.
We will also conduct semi-structured interviews with 30 VA clinicians to explore their knowledge and
perceptions on hypercalcemia and pHPT management, external barriers affecting compliance with guidelines
and their attitude towards possible interventions. Our goal is to reveal misconceptions, gaps in knowledge,
systemic limitations in the management of patients with pHPT in the VA, as well as to elicit input from the
providers on proposed interventions.
Next steps: The ...

## Key facts

- **NIH application ID:** 10595614
- **Project number:** 5I21HX003568-02
- **Recipient organization:** MICHAEL E DEBAKEY VA MEDICAL CENTER
- **Principal Investigator:** Konstantinos Makris
- **Activity code:** I21 (R01, R21, SBIR, etc.)
- **Funding institute:** VA
- **Fiscal year:** 2024
- **Award amount:** —
- **Award type:** 5
- **Project period:** 2022-04-01 → 2023-09-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10595614

## Citation

> US National Institutes of Health, RePORTER application 10595614, Understanding Reasons for Underdiagnosis and Undertreatment of Primary Hyperparathyroidism in the VA (5I21HX003568-02). Retrieved via AI Analytics 2026-05-24 from https://api.ai-analytics.org/grant/nih/10595614. Licensed CC0.

---

*[NIH grants dataset](/datasets/nih-grants) · CC0 1.0*