Patient and primary care provider experience using a family health history collection, risk stratification, and clinical decision support tool: a type 2 hybrid controlled implementation-effectiveness trial
Family health history (FHH) is the single strongest predictor of disease risk and yet is significantly underutilized in primary care. We developed a patient facing FHH collection tool, MeTree, that uses risk stratification to generate clinical decision support for breast cancer, colorectal cancer, o...
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| Veröffentlicht in: | BMC family practice 2013-08, Vol.14 (1), p.111-111, Article 111 |
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| creator | Wu, R Ryanne Orlando, Lori A Himmel, Tiffany L Buchanan, Adam H Powell, Karen P Hauser, Elizabeth R Agbaje, Astrid B Henrich, Vincent C Ginsburg, Geoffrey S |
| description | Family health history (FHH) is the single strongest predictor of disease risk and yet is significantly underutilized in primary care. We developed a patient facing FHH collection tool, MeTree, that uses risk stratification to generate clinical decision support for breast cancer, colorectal cancer, ovarian cancer, hereditary cancer syndromes, and thrombosis. Here we present data on the experience of patients and providers after integration of MeTree into 2 primary care practices.
This was a Type 2 hybrid controlled implementation-effectiveness study in 3 community-based primary care clinics in Greensboro, NC. All non-adopted adult English speaking patients with upcoming routine appointments were invited. Patients were recruited from December 2009 to the present and followed for one year. Ease of integration of MeTree into clinical practice at the two intervention clinics was evaluated through patient surveys after their appointment and at 3 months post-visit, and physician surveys 3 months after tool integration.
Total enrollment =1,184. Average time to complete MeTree = 27 minutes. Patients found MeTree: easy to use (93%), easy to understand (97%), useful (98%), raised awareness of disease risk (85%), and changed how they think about their health (86%). Of the 26% (N = 311) asking for assistance to complete the tool, age (65 sd 9.4 vs. 57 sd 11.8, p-value < 0.00) and large pedigree size (24.4 sd 9.81 vs. 22.2 sd 8.30, p-value < 0.00) were the only significant factors; 77% of those requiring assistance were over the age of 60. Providers (N = 14) found MeTree: improved their practice (86%), improved their understanding of FHH (64%), made practice easier (79%), and worthy of recommending to their peers (93%).
Our study shows that MeTree has broad acceptance and support from both patients and providers and can be implemented without disruption to workflow. |
| doi_str_mv | 10.1186/1471-2296-14-111 |
| format | Article |
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This was a Type 2 hybrid controlled implementation-effectiveness study in 3 community-based primary care clinics in Greensboro, NC. All non-adopted adult English speaking patients with upcoming routine appointments were invited. Patients were recruited from December 2009 to the present and followed for one year. Ease of integration of MeTree into clinical practice at the two intervention clinics was evaluated through patient surveys after their appointment and at 3 months post-visit, and physician surveys 3 months after tool integration.
Total enrollment =1,184. Average time to complete MeTree = 27 minutes. Patients found MeTree: easy to use (93%), easy to understand (97%), useful (98%), raised awareness of disease risk (85%), and changed how they think about their health (86%). Of the 26% (N = 311) asking for assistance to complete the tool, age (65 sd 9.4 vs. 57 sd 11.8, p-value < 0.00) and large pedigree size (24.4 sd 9.81 vs. 22.2 sd 8.30, p-value < 0.00) were the only significant factors; 77% of those requiring assistance were over the age of 60. Providers (N = 14) found MeTree: improved their practice (86%), improved their understanding of FHH (64%), made practice easier (79%), and worthy of recommending to their peers (93%).
Our study shows that MeTree has broad acceptance and support from both patients and providers and can be implemented without disruption to workflow.</description><identifier>ISSN: 1471-2296</identifier><identifier>EISSN: 1471-2296</identifier><identifier>DOI: 10.1186/1471-2296-14-111</identifier><identifier>PMID: 23915256</identifier><language>eng</language><publisher>England: BioMed Central Ltd</publisher><subject><![CDATA[Aged ; Attitude of Health Personnel ; Blood clot ; Breast Neoplasms - genetics ; Breast Neoplasms - prevention & control ; Cancer ; Colorectal Neoplasms - genetics ; Colorectal Neoplasms - prevention & control ; Decision Support Systems, Clinical ; Diagnosis ; Diagnosis, Computer-Assisted - methods ; Early Detection of Cancer - methods ; Family ; Family medical history ; Family medicine ; Female ; Genetic Predisposition to Disease ; Genetic susceptibility ; Health aspects ; Health risk assessment ; Health surveys ; Hospitals ; Humans ; Male ; Medical history taking ; Medical History Taking - methods ; Medical research ; Middle Aged ; Neoplasms - genetics ; Neoplasms - prevention & control ; Neoplastic Syndromes, Hereditary - genetics ; Neoplastic Syndromes, Hereditary - prevention & control ; Ovarian Neoplasms - genetics ; Ovarian Neoplasms - prevention & control ; Patient Acceptance of Health Care ; Patient satisfaction ; Primary care ; Primary Health Care - methods ; Risk Assessment - methods ; Studies ; Thrombosis ; Thrombosis - genetics ; Thrombosis - prevention & control]]></subject><ispartof>BMC family practice, 2013-08, Vol.14 (1), p.111-111, Article 111</ispartof><rights>COPYRIGHT 2013 BioMed Central Ltd.</rights><rights>2013 Wu et al.; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.</rights><rights>Copyright © 2013 Wu et al.; licensee BioMed Central Ltd. 2013 Wu et al.; licensee BioMed Central Ltd.</rights><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-b584t-d45fc875303a045c5b8d2eee3edd73d7709347bd4addcab6865d15b667a371663</citedby><cites>FETCH-LOGICAL-b584t-d45fc875303a045c5b8d2eee3edd73d7709347bd4addcab6865d15b667a371663</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC3765729/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC3765729/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,727,780,784,864,885,27924,27925,53791,53793</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/23915256$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Wu, R Ryanne</creatorcontrib><creatorcontrib>Orlando, Lori A</creatorcontrib><creatorcontrib>Himmel, Tiffany L</creatorcontrib><creatorcontrib>Buchanan, Adam H</creatorcontrib><creatorcontrib>Powell, Karen P</creatorcontrib><creatorcontrib>Hauser, Elizabeth R</creatorcontrib><creatorcontrib>Agbaje, Astrid B</creatorcontrib><creatorcontrib>Henrich, Vincent C</creatorcontrib><creatorcontrib>Ginsburg, Geoffrey S</creatorcontrib><title>Patient and primary care provider experience using a family health history collection, risk stratification, and clinical decision support tool: a type 2 hybrid controlled implementation-effectiveness trial</title><title>BMC family practice</title><addtitle>BMC Fam Pract</addtitle><description>Family health history (FHH) is the single strongest predictor of disease risk and yet is significantly underutilized in primary care. We developed a patient facing FHH collection tool, MeTree, that uses risk stratification to generate clinical decision support for breast cancer, colorectal cancer, ovarian cancer, hereditary cancer syndromes, and thrombosis. Here we present data on the experience of patients and providers after integration of MeTree into 2 primary care practices.
This was a Type 2 hybrid controlled implementation-effectiveness study in 3 community-based primary care clinics in Greensboro, NC. All non-adopted adult English speaking patients with upcoming routine appointments were invited. Patients were recruited from December 2009 to the present and followed for one year. Ease of integration of MeTree into clinical practice at the two intervention clinics was evaluated through patient surveys after their appointment and at 3 months post-visit, and physician surveys 3 months after tool integration.
Total enrollment =1,184. Average time to complete MeTree = 27 minutes. Patients found MeTree: easy to use (93%), easy to understand (97%), useful (98%), raised awareness of disease risk (85%), and changed how they think about their health (86%). Of the 26% (N = 311) asking for assistance to complete the tool, age (65 sd 9.4 vs. 57 sd 11.8, p-value < 0.00) and large pedigree size (24.4 sd 9.81 vs. 22.2 sd 8.30, p-value < 0.00) were the only significant factors; 77% of those requiring assistance were over the age of 60. Providers (N = 14) found MeTree: improved their practice (86%), improved their understanding of FHH (64%), made practice easier (79%), and worthy of recommending to their peers (93%).
Our study shows that MeTree has broad acceptance and support from both patients and providers and can be implemented without disruption to workflow.</description><subject>Aged</subject><subject>Attitude of Health Personnel</subject><subject>Blood clot</subject><subject>Breast Neoplasms - genetics</subject><subject>Breast Neoplasms - prevention & control</subject><subject>Cancer</subject><subject>Colorectal Neoplasms - genetics</subject><subject>Colorectal Neoplasms - prevention & control</subject><subject>Decision Support Systems, Clinical</subject><subject>Diagnosis</subject><subject>Diagnosis, Computer-Assisted - methods</subject><subject>Early Detection of Cancer - methods</subject><subject>Family</subject><subject>Family medical history</subject><subject>Family medicine</subject><subject>Female</subject><subject>Genetic Predisposition to Disease</subject><subject>Genetic susceptibility</subject><subject>Health aspects</subject><subject>Health risk assessment</subject><subject>Health surveys</subject><subject>Hospitals</subject><subject>Humans</subject><subject>Male</subject><subject>Medical history taking</subject><subject>Medical History Taking - methods</subject><subject>Medical research</subject><subject>Middle Aged</subject><subject>Neoplasms - genetics</subject><subject>Neoplasms - prevention & control</subject><subject>Neoplastic Syndromes, Hereditary - genetics</subject><subject>Neoplastic Syndromes, Hereditary - prevention & control</subject><subject>Ovarian Neoplasms - genetics</subject><subject>Ovarian Neoplasms - prevention & control</subject><subject>Patient Acceptance of Health Care</subject><subject>Patient satisfaction</subject><subject>Primary care</subject><subject>Primary Health Care - methods</subject><subject>Risk Assessment - methods</subject><subject>Studies</subject><subject>Thrombosis</subject><subject>Thrombosis - genetics</subject><subject>Thrombosis - prevention & control</subject><issn>1471-2296</issn><issn>1471-2296</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2013</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><recordid>eNqNkk9v1DAQxSMEoqVw54QsceFAShzHccKhUlXxT6oEBzhbjj3ZdXHiYDsr9kPynZiwy9JFRUI5xB7_5vlpnrPsKS3OKW3qV7QSNC_Lts5plVNK72Wnh9L9W-uT7FGMN0VBRVOWD7OTkrWUl7w-zX58UsnCmIgaDZmCHVTYEq0C4MZvrIFA4PsEARkNZI52XBFFejVYtyVrUC6tydrG5Jc27xzoZP34kgQbv5KYAqr3VqtdcblDOztiwRED2kYskzhPkw-JJO_daxRP2wlISdbbLljk_ZjCImyIHSYHA5r9JZdD3y-3bWCEGEkKVrnH2YNeuQhP9v-z7MvbN5-v3ufXH999uLq8zjveVCk3Fe91IzgrmCoqrnnXmBIAGBgjmBGiaFklOlMpY7Tq6qbmhvKuroVigtY1O8sudrrT3A1gNHoKysn9_KRXVh6fjHYtV34jmai5KFsUuNoJdNb_Q-D4RPtBLnHKJU5cSUwbVV7sbQT_bYaY5GCjBufUCH6OiHHMmdd18x8oqwpWtpVA9Plf6I2fw4jzRKpseSkQ_kOtlANpx96jT72IykvOKt40aBSp8zso_AwMFqOF3mL9qKHYNejgYwzQH2ZCC7m8-bum8Ox2GIeG34-c_QTRjgGR</recordid><startdate>20130806</startdate><enddate>20130806</enddate><creator>Wu, R Ryanne</creator><creator>Orlando, Lori A</creator><creator>Himmel, Tiffany L</creator><creator>Buchanan, Adam H</creator><creator>Powell, Karen P</creator><creator>Hauser, Elizabeth R</creator><creator>Agbaje, Astrid B</creator><creator>Henrich, Vincent C</creator><creator>Ginsburg, Geoffrey S</creator><general>BioMed Central Ltd</general><general>BioMed Central</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>PIMPY</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7T2</scope><scope>7U1</scope><scope>7U2</scope><scope>C1K</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>20130806</creationdate><title>Patient and primary care provider experience using a family health history collection, risk stratification, and clinical decision support tool: a type 2 hybrid controlled implementation-effectiveness trial</title><author>Wu, R Ryanne ; Orlando, Lori A ; Himmel, Tiffany L ; Buchanan, Adam H ; Powell, Karen P ; Hauser, Elizabeth R ; Agbaje, Astrid B ; Henrich, Vincent C ; Ginsburg, Geoffrey S</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-b584t-d45fc875303a045c5b8d2eee3edd73d7709347bd4addcab6865d15b667a371663</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2013</creationdate><topic>Aged</topic><topic>Attitude of Health Personnel</topic><topic>Blood clot</topic><topic>Breast Neoplasms - genetics</topic><topic>Breast Neoplasms - prevention & control</topic><topic>Cancer</topic><topic>Colorectal Neoplasms - genetics</topic><topic>Colorectal Neoplasms - prevention & control</topic><topic>Decision Support Systems, Clinical</topic><topic>Diagnosis</topic><topic>Diagnosis, Computer-Assisted - methods</topic><topic>Early Detection of Cancer - methods</topic><topic>Family</topic><topic>Family medical history</topic><topic>Family medicine</topic><topic>Female</topic><topic>Genetic Predisposition to Disease</topic><topic>Genetic susceptibility</topic><topic>Health aspects</topic><topic>Health risk assessment</topic><topic>Health surveys</topic><topic>Hospitals</topic><topic>Humans</topic><topic>Male</topic><topic>Medical history taking</topic><topic>Medical History Taking - methods</topic><topic>Medical research</topic><topic>Middle Aged</topic><topic>Neoplasms - genetics</topic><topic>Neoplasms - prevention & control</topic><topic>Neoplastic Syndromes, Hereditary - genetics</topic><topic>Neoplastic Syndromes, Hereditary - prevention & control</topic><topic>Ovarian Neoplasms - genetics</topic><topic>Ovarian Neoplasms - prevention & control</topic><topic>Patient Acceptance of Health Care</topic><topic>Patient satisfaction</topic><topic>Primary care</topic><topic>Primary Health Care - methods</topic><topic>Risk Assessment - methods</topic><topic>Studies</topic><topic>Thrombosis</topic><topic>Thrombosis - genetics</topic><topic>Thrombosis - prevention & control</topic><toplevel>online_resources</toplevel><creatorcontrib>Wu, R Ryanne</creatorcontrib><creatorcontrib>Orlando, Lori A</creatorcontrib><creatorcontrib>Himmel, Tiffany L</creatorcontrib><creatorcontrib>Buchanan, Adam H</creatorcontrib><creatorcontrib>Powell, Karen P</creatorcontrib><creatorcontrib>Hauser, Elizabeth R</creatorcontrib><creatorcontrib>Agbaje, Astrid B</creatorcontrib><creatorcontrib>Henrich, Vincent C</creatorcontrib><creatorcontrib>Ginsburg, Geoffrey S</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Access via ProQuest (Open Access)</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>Health and Safety Science Abstracts (Full archive)</collection><collection>Risk Abstracts</collection><collection>Safety Science and Risk</collection><collection>Environmental Sciences and Pollution Management</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>BMC family practice</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Wu, R Ryanne</au><au>Orlando, Lori A</au><au>Himmel, Tiffany L</au><au>Buchanan, Adam H</au><au>Powell, Karen P</au><au>Hauser, Elizabeth R</au><au>Agbaje, Astrid B</au><au>Henrich, Vincent C</au><au>Ginsburg, Geoffrey S</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Patient and primary care provider experience using a family health history collection, risk stratification, and clinical decision support tool: a type 2 hybrid controlled implementation-effectiveness trial</atitle><jtitle>BMC family practice</jtitle><addtitle>BMC Fam Pract</addtitle><date>2013-08-06</date><risdate>2013</risdate><volume>14</volume><issue>1</issue><spage>111</spage><epage>111</epage><pages>111-111</pages><artnum>111</artnum><issn>1471-2296</issn><eissn>1471-2296</eissn><abstract>Family health history (FHH) is the single strongest predictor of disease risk and yet is significantly underutilized in primary care. We developed a patient facing FHH collection tool, MeTree, that uses risk stratification to generate clinical decision support for breast cancer, colorectal cancer, ovarian cancer, hereditary cancer syndromes, and thrombosis. Here we present data on the experience of patients and providers after integration of MeTree into 2 primary care practices.
This was a Type 2 hybrid controlled implementation-effectiveness study in 3 community-based primary care clinics in Greensboro, NC. All non-adopted adult English speaking patients with upcoming routine appointments were invited. Patients were recruited from December 2009 to the present and followed for one year. Ease of integration of MeTree into clinical practice at the two intervention clinics was evaluated through patient surveys after their appointment and at 3 months post-visit, and physician surveys 3 months after tool integration.
Total enrollment =1,184. Average time to complete MeTree = 27 minutes. Patients found MeTree: easy to use (93%), easy to understand (97%), useful (98%), raised awareness of disease risk (85%), and changed how they think about their health (86%). Of the 26% (N = 311) asking for assistance to complete the tool, age (65 sd 9.4 vs. 57 sd 11.8, p-value < 0.00) and large pedigree size (24.4 sd 9.81 vs. 22.2 sd 8.30, p-value < 0.00) were the only significant factors; 77% of those requiring assistance were over the age of 60. Providers (N = 14) found MeTree: improved their practice (86%), improved their understanding of FHH (64%), made practice easier (79%), and worthy of recommending to their peers (93%).
Our study shows that MeTree has broad acceptance and support from both patients and providers and can be implemented without disruption to workflow.</abstract><cop>England</cop><pub>BioMed Central Ltd</pub><pmid>23915256</pmid><doi>10.1186/1471-2296-14-111</doi><tpages>1</tpages><oa>free_for_read</oa></addata></record> |
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| source | MEDLINE; DOAJ Directory of Open Access Journals; PubMed Central Open Access; PubMed Central |
| subjects | Aged Attitude of Health Personnel Blood clot Breast Neoplasms - genetics Breast Neoplasms - prevention & control Cancer Colorectal Neoplasms - genetics Colorectal Neoplasms - prevention & control Decision Support Systems, Clinical Diagnosis Diagnosis, Computer-Assisted - methods Early Detection of Cancer - methods Family Family medical history Family medicine Female Genetic Predisposition to Disease Genetic susceptibility Health aspects Health risk assessment Health surveys Hospitals Humans Male Medical history taking Medical History Taking - methods Medical research Middle Aged Neoplasms - genetics Neoplasms - prevention & control Neoplastic Syndromes, Hereditary - genetics Neoplastic Syndromes, Hereditary - prevention & control Ovarian Neoplasms - genetics Ovarian Neoplasms - prevention & control Patient Acceptance of Health Care Patient satisfaction Primary care Primary Health Care - methods Risk Assessment - methods Studies Thrombosis Thrombosis - genetics Thrombosis - prevention & control |
| title | Patient and primary care provider experience using a family health history collection, risk stratification, and clinical decision support tool: a type 2 hybrid controlled implementation-effectiveness trial |
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