Health Information Technology (HIT) Enhanced Family History Documentation and Management in Primary Care
Condition: Colorectal Cancer; Breast Cancer; Coronary Heart Disease; Diabetes
MeSH terms: Heart Diseases; Coronary Disease; Coronary Artery Disease; Myocardial Ischemia
Study type: Interventional

Summary: 
      We evaluated whether collection of risk factors to generate an electronic health record
      (EHR)-linked personalized health risk appraisal (HRA) for coronary heart disease (CHD),
      diabetes, breast and colorectal cancer (CRC) was associated with improved patient-provider
      communication, risk assessment, and breast cancer screening plans in the next year.
    

Detailed description: 
      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,
      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.
    

Intervention name(s): Intervention
Intervention type(s): Other
Intervention description(s): risk assessment survey; decision support for providers for prevention based on risk
Other intervention name(s): Risk Assessment and Prevention Recommendations
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Prevention