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Implementation-effectiveness trial of systematic family health history based risk assessment and impact on clinical disease prevention and surveillance activities

BACKGROUND: Systematically assessing disease risk can improve population health by identifying those eligible for enhanced prevention/screening strategies. This study aims to determine the clinical impact of a systematic risk assessment in diverse primary care populations. METHODS: Hybrid implementa...

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Autores principales: Wu, R. Ryanne, Myers, Rachel A., Neuner, Joan, McCarty, Catherine, Haller, Irina V., Harry, Melissa, Fulda, Kimberly G., Dimmock, David, Rakhra-Burris, Tejinder, Buchanan, Adam, Ginsburg, Geoffrey S., Orlando, Lori A.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9727967/
https://www.ncbi.nlm.nih.gov/pubmed/36474257
http://dx.doi.org/10.1186/s12913-022-08879-2
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author Wu, R. Ryanne
Myers, Rachel A.
Neuner, Joan
McCarty, Catherine
Haller, Irina V.
Harry, Melissa
Fulda, Kimberly G.
Dimmock, David
Rakhra-Burris, Tejinder
Buchanan, Adam
Ginsburg, Geoffrey S.
Orlando, Lori A.
author_facet Wu, R. Ryanne
Myers, Rachel A.
Neuner, Joan
McCarty, Catherine
Haller, Irina V.
Harry, Melissa
Fulda, Kimberly G.
Dimmock, David
Rakhra-Burris, Tejinder
Buchanan, Adam
Ginsburg, Geoffrey S.
Orlando, Lori A.
author_sort Wu, R. Ryanne
collection PubMed
description BACKGROUND: Systematically assessing disease risk can improve population health by identifying those eligible for enhanced prevention/screening strategies. This study aims to determine the clinical impact of a systematic risk assessment in diverse primary care populations. METHODS: Hybrid implementation-effectiveness trial of a family health history-based health risk assessment (HRA) tied to risk-based guideline recommendations enrolling from 2014–2017 with 12 months of post-intervention survey data and 24 months of electronic medical record (EMR) data capture. Setting:19 primary care clinics at four geographically and culturally diverse U.S. healthcare systems. Participants: any English or Spanish-speaking adult with an upcoming appointment at an enrolling clinic. Methods: A personal and family health history based HRA with integrated guideline-based clinical decision support (CDS) was completed by each participant prior to their appointment. Risk reports were provided to patients and providers to discuss at their clinical encounter. Outcomes: provider and patient discussion and provider uptake (i.e. ordering) and patient uptake (i.e. recommendation completion) of CDS recommendations. Measures: patient and provider surveys and EMR data. RESULTS: One thousand eight hundred twenty nine participants (mean age 56.2 [SD13.9], 69.6% female) completed the HRA and had EMR data available for analysis. 762 (41.6%) received a recommendation (29.7% for genetic counseling (GC); 15.2% for enhanced breast/colon cancer screening). Those with recommendations frequently discussed disease risk with their provider (8.7%-38.2% varied by recommendation, p-values ≤ 0.004). In the GC subgroup, provider discussions increased referrals to counseling (44.4% with vs. 5.9% without, P < 0.001). Recommendation uptake was highest for colon cancer screening (provider = 67.9%; patient = 86.8%) and lowest for breast cancer chemoprevention (0%). CONCLUSIONS: Systematic health risk assessment revealed that almost half the population were at increased disease risk based on guidelines. Risk identification resulted in shared discussions between participants and providers but variable clinical action uptake depending upon the recommendation. Understanding the barriers and facilitators to uptake by both patients and providers will be essential for optimizing HRA tools and achieving their promise of improving population health. TRIAL REGISTRATION: Clinicaltrials.gov number NCT01956773, registered 10/8/2013. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12913-022-08879-2.
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spelling pubmed-97279672022-12-08 Implementation-effectiveness trial of systematic family health history based risk assessment and impact on clinical disease prevention and surveillance activities Wu, R. Ryanne Myers, Rachel A. Neuner, Joan McCarty, Catherine Haller, Irina V. Harry, Melissa Fulda, Kimberly G. Dimmock, David Rakhra-Burris, Tejinder Buchanan, Adam Ginsburg, Geoffrey S. Orlando, Lori A. BMC Health Serv Res Research Article BACKGROUND: Systematically assessing disease risk can improve population health by identifying those eligible for enhanced prevention/screening strategies. This study aims to determine the clinical impact of a systematic risk assessment in diverse primary care populations. METHODS: Hybrid implementation-effectiveness trial of a family health history-based health risk assessment (HRA) tied to risk-based guideline recommendations enrolling from 2014–2017 with 12 months of post-intervention survey data and 24 months of electronic medical record (EMR) data capture. Setting:19 primary care clinics at four geographically and culturally diverse U.S. healthcare systems. Participants: any English or Spanish-speaking adult with an upcoming appointment at an enrolling clinic. Methods: A personal and family health history based HRA with integrated guideline-based clinical decision support (CDS) was completed by each participant prior to their appointment. Risk reports were provided to patients and providers to discuss at their clinical encounter. Outcomes: provider and patient discussion and provider uptake (i.e. ordering) and patient uptake (i.e. recommendation completion) of CDS recommendations. Measures: patient and provider surveys and EMR data. RESULTS: One thousand eight hundred twenty nine participants (mean age 56.2 [SD13.9], 69.6% female) completed the HRA and had EMR data available for analysis. 762 (41.6%) received a recommendation (29.7% for genetic counseling (GC); 15.2% for enhanced breast/colon cancer screening). Those with recommendations frequently discussed disease risk with their provider (8.7%-38.2% varied by recommendation, p-values ≤ 0.004). In the GC subgroup, provider discussions increased referrals to counseling (44.4% with vs. 5.9% without, P < 0.001). Recommendation uptake was highest for colon cancer screening (provider = 67.9%; patient = 86.8%) and lowest for breast cancer chemoprevention (0%). CONCLUSIONS: Systematic health risk assessment revealed that almost half the population were at increased disease risk based on guidelines. Risk identification resulted in shared discussions between participants and providers but variable clinical action uptake depending upon the recommendation. Understanding the barriers and facilitators to uptake by both patients and providers will be essential for optimizing HRA tools and achieving their promise of improving population health. TRIAL REGISTRATION: Clinicaltrials.gov number NCT01956773, registered 10/8/2013. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12913-022-08879-2. BioMed Central 2022-12-06 /pmc/articles/PMC9727967/ /pubmed/36474257 http://dx.doi.org/10.1186/s12913-022-08879-2 Text en © The Author(s) 2022 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/ (https://creativecommons.org/publicdomain/zero/1.0/) ) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
spellingShingle Research Article
Wu, R. Ryanne
Myers, Rachel A.
Neuner, Joan
McCarty, Catherine
Haller, Irina V.
Harry, Melissa
Fulda, Kimberly G.
Dimmock, David
Rakhra-Burris, Tejinder
Buchanan, Adam
Ginsburg, Geoffrey S.
Orlando, Lori A.
Implementation-effectiveness trial of systematic family health history based risk assessment and impact on clinical disease prevention and surveillance activities
title Implementation-effectiveness trial of systematic family health history based risk assessment and impact on clinical disease prevention and surveillance activities
title_full Implementation-effectiveness trial of systematic family health history based risk assessment and impact on clinical disease prevention and surveillance activities
title_fullStr Implementation-effectiveness trial of systematic family health history based risk assessment and impact on clinical disease prevention and surveillance activities
title_full_unstemmed Implementation-effectiveness trial of systematic family health history based risk assessment and impact on clinical disease prevention and surveillance activities
title_short Implementation-effectiveness trial of systematic family health history based risk assessment and impact on clinical disease prevention and surveillance activities
title_sort implementation-effectiveness trial of systematic family health history based risk assessment and impact on clinical disease prevention and surveillance activities
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9727967/
https://www.ncbi.nlm.nih.gov/pubmed/36474257
http://dx.doi.org/10.1186/s12913-022-08879-2
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