Use of a Web-based Risk Appraisal Tool for Assessing Family History and Lifestyle Factors in Primary Care
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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.
We evaluated the feasibility and effectiveness of using a web-based risk appraisal tool in the primary care setting.
Five primary care practices within an academic care network were assigned to the intervention or control group.
We included 15,495 patients who had a new patient visit or annual exam during an 8-month period in 2010–2011.
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.
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.
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.
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.
KEY WORDSrisk appraisal family history cancer primary care
We thank all of the clinicians, staff, and patients at the primary care practices who participated in the study.
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).
Some of this manuscript was presented as a poster at the annual meeting of the Society of General Internal Medicine in Orlando, Florida, in May 2012.
Conflict of Interest
The creators and owners of Your Health Snapshot (Dr. Graham Colditz and Mr. Hank Dart, at Washington University School of Medicine) collaborated on some aspects of the study design and are included as co-authors on the paper. However, the authors had no financial relationship with them and they did not have access to the data or participate in the statistical analyses.
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