Background: Risk assessment with a thorough family health history is recommended by numerous organizations and is now a required component of the annual physical for Medicare beneficiaries under the Affordable Care Act. However, there are several barriers to incorporating robust risk assessments into routine care. MeTree, a web-based patient-facing health risk assessment tool, was developed with the aim of overcoming these barriers. In order to better understand what factors will be instrumental for broader adoption of risk assessment programs like MeTree in clinical settings, we obtained funding to perform a type III hybrid implementation-effectiveness study in primary care clinics at five diverse healthcare systems. Here, we describe the study's protocol. Methods/design: MeTree collects personal medical information and a three-generation family health history from patients on 98 conditions. Using algorithms built entirely from current clinical guidelines, it provides clinical decision support to providers and patients on 30 conditions. All adult patients with an upcoming well-visit appointment at one of the 20 intervention clinics are eligible to participate. Patient-oriented risk reports are provided in real time. Provider-oriented risk reports are uploaded to the electronic medical record for review at the time of the appointment. Implementation outcomes are enrollment rate of clinics, providers, and patients (enrolled vs approached) and their representativeness compared to the underlying population. Primary effectiveness outcomes are the percent of participants newly identified as being at increased risk for one of the clinical decision support conditions and the percent with appropriate risk-based screening. Secondary outcomes include percent change in those meeting goals for a healthy lifestyle (diet, exercise, and smoking). Outcomes are measured through electronic medical record data abstraction, patient surveys, and surveys/qualitative interviews of clinical staff. Discussion: This study evaluates factors that are critical to successful implementation of a web-based risk assessment tool into routine clinical care in a variety of healthcare settings. The result will identify resource needs and potential barriers and solutions to implementation in each setting as well as an understanding potential effectiveness.
|Original language||English (US)|
|State||Published - Nov 24 2015|
Bibliographical noteFunding Information:
This paper was written on behalf of the Family Health History Network which in addition to listed authors include Tejinder Rakhra-Burris, Michael Musty, Adam Buchanan, Corrine Voils, Nina Sperber, Dana Creighton Baker, Bruce Peyser, Gloria Trujillo, Lynn Bowlby, J. Franklin Mills, Alison LaPean Kirschner, Hollie Beaudry, Jill Paradowski, Molly Johnston, Joseph Bianco, David Hyjek, Jeanette Palcher, and Irina Haller. This study was funded by NIH grant no. 1 U01 HG007282 and the funder had no involvement in the design, conduct, data collection, analysis, or manuscript preparation. This study was approved by the IRBs at all five institutions and the funders: Duke University, Medical College of Wisconsin, Essentia Institute of Rural Health, University of North Texas, and David Grant U.S. Air Force Medical center.
These encouraging results led to grant funding from NHGRI and NCI as part of the Implementing Genomics in Practice (IGNITE) network (http://www.ignite-genomics.org) to optimize MeTree and evaluate its uptake and impact across a variety of diverse real world settings. Optimization and expansion of MeTree have been completed and include a tablet friendly user interface, help text linked to MedlinePlus Connect, incorporation of American Health Information Community’s requirements for FHH collection , full HL7 standards compatibility (www.hl7.org), data linked to ICD-9 and SNOMED codes for interoperability, data collection for 90 conditions, clinical decision support for 30 conditions (breast cancer, colon cancer, lung cancer, ovarian cancer, hereditary cancer syndrome, hereditary cardiovascular diseases, connective tissue diseases, hereditary liver diseases, abdominal aortic aneurysm, type 2 diabetes, coronary artery disease, and ischemic stroke), and the addition of a Spanish version. In this paper, we describe the pragmatic cluster controlled implementation-effectiveness hybrid type III trial designed to evaluate the implementation uptake and clinical utility of MeTree in five diverse healthcare systems across the USA.
© 2015 Wu et al.
- Family health history
- Primary care
- Risk stratification