Growing evidence and understanding of an inherited component to several common, chronic diseases has led to an increase in the importance of information about family health history, and the integration of this information with other risk factors for common diseases, like lifestyle risk factors. The US Preventive Services Task Force (USPSTF) recommends the use of family health history as a routine genetic screening test for common diseases, as obtaining a complete family health history is the first step to identifying patients who are in need of intervention (e.g., intensive screening, lifestyle modification, preventative therapies, and genetic counseling). The importance of integrating family health history with an individual's medical record will increase as our understanding of the genome evolves because it will be more essential to put detailed personal genetic information into a clinical context. Because of limited time during a typical primary care visit, and the concerns of primary care providers (PCPs) about their self-efficacy of estimating and providing guidance about risk, PCPs frequently do not obtain a family health history or provide individualized risk assessment. These issues highlight the need to leverage technology to collect these data independent of clinic visits, yet have these data interoperate with an individual's electronic health record (EHR). Telephonic interactive voice response systems (IVRS) and self-administered web-based tools are a low-cost, sustainable way of reaching out to primary care populations, independent of a visit. We propose to develop, implement, and evaluate a patient-reported, EHR- integrated personalized risk assessment module to provide tailored disease risk and risk reduction information.
The Specific Aims of the proposed project are to:
Aim 1 : Develop a patient-reported, EHR-integrated, personalized risk assessment module to provide tailored disease risk and risk reduction information for four common diseases (breast cancer, colorectal cancer, coronary heart disease, and type II diabetes) for the patient and his/ her PCP.
Aim 2 : Measure the reach and effectiveness of this integrated risk assessment module by conducting a cluster randomized controlled trial (RCT) of adult primary care patients in the Brigham and Women's Primary Care Practice-Based Research Network.
Aim 3 : Evaluate facilitators and barriers to the adoption and implementation of this integrated risk assessment module. This project will further our understanding of how technology can be used to fill a gap in current clinical practice by facilitating the systematic collection of family health history and lifestyle risk factor data and integrating these data with an individual's EHR to personalize care in a variety of settings and for diverse patient populations. This work will use current national data standards for interoperability, and lessons learned from this project will be exportable to healthcare settings throughout the United States.

Public Health Relevance

We propose to develop and evaluate a patient-reported, electronic health record (EHR)-integrated, personalized risk assessment module to provide tailored disease risk and risk reduction information for four common diseases (breast cancer, colorectal cancer, coronary heart disease, and type II diabetes) for the patient and his/ her primary care physician (PCP). We will allow a patient to choose either a telephonic interactive voice response system or a secure web-based tool to collect family health history and lifestyle risk factors before a PCP visit, integrate these data with a patient's EHR, and provide patients and their PCP with a personalized report with suggestions for risk reduction. This project will further our understanding of how technology can be used to fill a gap in current practice by facilitating the systematic collection of family health history and lifestyle risk factors and integrating these data with an individual's EHR.

Agency
National Institute of Health (NIH)
Institute
Agency for Healthcare Research and Quality (AHRQ)
Type
Research Demonstration and Dissemination Projects (R18)
Project #
1R18HS018644-01A1
Application #
8150146
Study Section
Health Systems Research (HSR)
Program Officer
Nunley, Angela
Project Start
2011-09-30
Project End
2014-07-31
Budget Start
2011-09-30
Budget End
2012-07-31
Support Year
1
Fiscal Year
2011
Total Cost
Indirect Cost
Name
Brigham and Women's Hospital
Department
Type
DUNS #
030811269
City
Boston
State
MA
Country
United States
Zip Code
02115
Haas, Jennifer S; Baer, Heather J; Eibensteiner, Katyuska et al. (2017) A Cluster Randomized Trial of a Personalized Multi-Condition Risk Assessment in Primary Care. Am J Prev Med 52:100-105