TY - JOUR
T1 - Use of a web-based risk appraisal tool for assessing family history and lifestyle factors in primary care
AU - Baer, Heather J.
AU - Schneider, Louise I.
AU - Colditz, Graham A.
AU - Dart, Hank
AU - Andry, Analisa
AU - Williams, Deborah H.
AU - Orav, E. John
AU - Haas, Jennifer S.
AU - Getty, George
AU - Whittemore, Elizabeth
AU - Bates, David W.
N1 - Funding Information:
Funders: This study was supported by grants from the CRICO/ Risk Management Foundation of the Harvard Medical Institutions and from the National Human Genome Research Institute (1RC1HG005331). Dr. Baer also was supported by a Mentored Research Scientist Career Development Award from the Agency for Healthcare Research and Quality (K01HS019789).
PY - 2013/6
Y1 - 2013/6
N2 - BACKGROUND: Primary care clinicians can play an important role in identifying individuals at increased risk of cancer, but often do not obtain detailed information on family history or lifestyle factors from their patients. OBJECTIVE: We evaluated the feasibility and effectiveness of using a web-based risk appraisal tool in the primary care setting. DESIGN: Five primary care practices within an academic care network were assigned to the intervention or control group. PARTICIPANTS: We included 15,495 patients who had a new patient visit or annual exam during an 8-month period in 2010-2011. INTERVENTION: Intervention patients were asked to complete a web-based risk appraisal tool on a laptop computer immediately before their visit. Information on family history of cancer was sent to their electronic health record (EHR) for clinicians to view; if accepted, it populated coded fields and could trigger clinician reminders about colon and breast cancer screening. MAIN MEASURES: The main outcome measure was new documentation of a positive family history of cancer in coded EHR fields. Secondary outcomes included clinician reminders about screening and discussion of family history, lifestyle factors, and screening. KEY RESULTS: Among eligible intervention patients, 2.0 % had new information on family history of cancer entered in the EHR within 30 days after the visit, compared to 0.6 % of eligible control patients (adjusted odds ratio = 4.3, p = 0.03). There were no significant differences in the percent of patients who received moderate or high risk reminders for colon or breast cancer screening. CONCLUSIONS: Use of this tool was associated with increased documentation of family history of cancer in the EHR, although the percentage of patients with new family history information was low in both groups. Further research is needed to determine how risk appraisal tools can be integrated with workflow and how they affect screening and health behaviors.
AB - BACKGROUND: Primary care clinicians can play an important role in identifying individuals at increased risk of cancer, but often do not obtain detailed information on family history or lifestyle factors from their patients. OBJECTIVE: We evaluated the feasibility and effectiveness of using a web-based risk appraisal tool in the primary care setting. DESIGN: Five primary care practices within an academic care network were assigned to the intervention or control group. PARTICIPANTS: We included 15,495 patients who had a new patient visit or annual exam during an 8-month period in 2010-2011. INTERVENTION: Intervention patients were asked to complete a web-based risk appraisal tool on a laptop computer immediately before their visit. Information on family history of cancer was sent to their electronic health record (EHR) for clinicians to view; if accepted, it populated coded fields and could trigger clinician reminders about colon and breast cancer screening. MAIN MEASURES: The main outcome measure was new documentation of a positive family history of cancer in coded EHR fields. Secondary outcomes included clinician reminders about screening and discussion of family history, lifestyle factors, and screening. KEY RESULTS: Among eligible intervention patients, 2.0 % had new information on family history of cancer entered in the EHR within 30 days after the visit, compared to 0.6 % of eligible control patients (adjusted odds ratio = 4.3, p = 0.03). There were no significant differences in the percent of patients who received moderate or high risk reminders for colon or breast cancer screening. CONCLUSIONS: Use of this tool was associated with increased documentation of family history of cancer in the EHR, although the percentage of patients with new family history information was low in both groups. Further research is needed to determine how risk appraisal tools can be integrated with workflow and how they affect screening and health behaviors.
KW - cancer
KW - family history
KW - primary care
KW - risk appraisal
UR - http://www.scopus.com/inward/record.url?scp=84878602337&partnerID=8YFLogxK
U2 - 10.1007/s11606-013-2338-z
DO - 10.1007/s11606-013-2338-z
M3 - Article
C2 - 23371384
AN - SCOPUS:84878602337
SN - 0884-8734
VL - 28
SP - 817
EP - 824
JO - Journal of general internal medicine
JF - Journal of general internal medicine
IS - 6
ER -