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Wu RR, Myers RA, Neuner J, McCarty C, Haller IV, Harry M, Fulda KG, Dimmock D, Rakhra-Burris T, Buchanan A, Ginsburg GS, Orlando LA. Implementation-effectiveness trial of systematic family health history based risk assessment and impact on clinical disease prevention and surveillance activities. BMC Health Serv Res 2022; 22:1486. [PMID: 36474257 PMCID: PMC9727967 DOI: 10.1186/s12913-022-08879-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 11/23/2022] [Indexed: 12/12/2022] Open
Abstract
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.
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Affiliation(s)
- R. Ryanne Wu
- grid.26009.3d0000 0004 1936 7961Center for Applied Genomics and Precision Medicine, Department of Medicine, Duke University School of Medicine, Durham, NC USA ,grid.428397.30000 0004 0385 0924Duke-NUS Medical School, Programme in Health Services and Systems Research, Singapore, Singapore
| | - Rachel A. Myers
- grid.26009.3d0000 0004 1936 7961Center for Applied Genomics and Precision Medicine, Department of Medicine, Duke University School of Medicine, Durham, NC USA
| | - Joan Neuner
- grid.30760.320000 0001 2111 8460Department of Medicine, Medical College of Wisconsin, Milwaukee, WI USA ,grid.30760.320000 0001 2111 8460Center for Patient Care and Outcomes Research, Medical College of Wisconsin, Milwaukee, WI USA
| | - Catherine McCarty
- grid.17635.360000000419368657University of Minnesota Medical School, Duluth Campus, Duluth, MN USA
| | - Irina V. Haller
- grid.428919.f0000 0004 0449 6525Essentia Institute of Rural Health, Duluth, MN USA
| | - Melissa Harry
- grid.428919.f0000 0004 0449 6525Essentia Institute of Rural Health, Duluth, MN USA
| | - Kimberly G. Fulda
- grid.266871.c0000 0000 9765 6057The North Texas Primary Care Practice-Based Research Network and Family Medicine, University of North Texas Health Science Center, Fort Worth, TX USA
| | - David Dimmock
- grid.286440.c0000 0004 0383 2910Rady Children’s Institute for Genomic Medicine, San Diego, CA USA
| | - Tejinder Rakhra-Burris
- grid.26009.3d0000 0004 1936 7961Center for Applied Genomics and Precision Medicine, Department of Medicine, Duke University School of Medicine, Durham, NC USA
| | - Adam Buchanan
- grid.280776.c0000 0004 0394 1447Genomic Medicine Institute, Geisinger, Geisinger, PA USA
| | - Geoffrey S. Ginsburg
- grid.94365.3d0000 0001 2297 5165All of Us Research Program, National Institutes of Health, Bethesda, MD USA
| | - Lori A. Orlando
- grid.26009.3d0000 0004 1936 7961Center for Applied Genomics and Precision Medicine, Department of Medicine, Duke University School of Medicine, Durham, NC USA
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Liebermann E, Taber P, Vega AS, Daly BM, Goodman MS, Bradshaw R, Chan PA, Chavez-Yenter D, Hess R, Kessler C, Kohlmann W, Low S, Monahan R, Kawamoto K, Del Fiol G, Buys SS, Sigireddi M, Ginsburg O, Kaphingst KA. Barriers to family history collection among Spanish-speaking primary care patients: a BRIDGE qualitative study. PEC INNOVATION 2022; 1:100087. [PMID: 36532299 PMCID: PMC9757734 DOI: 10.1016/j.pecinn.2022.100087] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Objectives Family history is an important tool for assessing disease risk, and tailoring recommendations for screening and genetic services referral. This study explored barriers to family history collection with Spanish-speaking patients. Methods This qualitative study was conducted in two US healthcare systems. We conducted semi-structured interviews with medical assistants, physicians, and interpreters with experience collecting family history for Spanish-speaking patients. Results The most common patient-level barrier was the perception that some Spanish-speaking patients had limited knowledge of family history. Interpersonal communication barriers related to dialectical differences and decisions about using formal interpreters vs. Spanish-speaking staff. Organizational barriers included time pressures related to using interpreters, and ad hoc workflow adaptations for Spanish-speaking patients that might leave gaps in family history collection. Conclusions This study identified multi-level barriers to family history collection with Spanish-speaking patients in primary care. Findings suggest that a key priority to enhance communication would be to standardize processes for working with interpreters. Innovation To improve communication with and care provided to Spanish-speaking patients, there is a need to increase healthcare provider awareness about implicit bias, to address ad hoc workflow adjustments within practice settings, to evaluate the need for professional interpreter services, and to improve digital tools to facilitate family history collection.
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Affiliation(s)
- Erica Liebermann
- College of Nursing, University of Rhode Island, RINEC, 350 Eddy Street, Providence, RI 02903, USA
| | - Peter Taber
- Department of Biomedical Informatics, University of Utah, 421 Wakara Way, Suite 140, Salt Lake City, UT 84108, USA
| | - Alexis S Vega
- Department of Communication, University of Utah, 255 S. Central Campus Drive, Salt Lake City, UT 84112, USA
| | - Brianne M Daly
- Huntsman Cancer Institute, 2000 Circle of Hope Drive, Salt Lake City, UT 84112, USA
| | - Melody S Goodman
- School of Global Public Health, New York University, 726 Broadway, New York, NY 10012, USA
| | - Richard Bradshaw
- Department of Biomedical Informatics, University of Utah, 421 Wakara Way, Suite 140, Salt Lake City, UT 84108, USA
| | - Priscilla A Chan
- Perlmutter Cancer Center, NYU Langone Health, 160 E. 34th Street, New York, NY 10016, USA
| | - Daniel Chavez-Yenter
- Department of Communication, University of Utah, 255 S. Central Campus Drive, Salt Lake City, UT 84112, USA
- Huntsman Cancer Institute, 2000 Circle of Hope Drive, Salt Lake City, UT 84112, USA
| | - Rachel Hess
- Department of Population Health Sciences, University of Utah, 295 Chipeta Way, Salt Lake City, UT, 84108, USA
| | - Cecilia Kessler
- Huntsman Cancer Institute, 2000 Circle of Hope Drive, Salt Lake City, UT 84112, USA
| | - Wendy Kohlmann
- Huntsman Cancer Institute, 2000 Circle of Hope Drive, Salt Lake City, UT 84112, USA
| | - Sara Low
- Huntsman Cancer Institute, 2000 Circle of Hope Drive, Salt Lake City, UT 84112, USA
| | - Rachel Monahan
- Perlmutter Cancer Center, NYU Langone Health, 160 E. 34th Street, New York, NY 10016, USA
| | - Kensaku Kawamoto
- Department of Biomedical Informatics, University of Utah, 421 Wakara Way, Suite 140, Salt Lake City, UT 84108, USA
| | - Guilherme Del Fiol
- Department of Biomedical Informatics, University of Utah, 421 Wakara Way, Suite 140, Salt Lake City, UT 84108, USA
| | - Saundra S Buys
- Huntsman Cancer Institute, 2000 Circle of Hope Drive, Salt Lake City, UT 84112, USA
- Department of Internal Medicine, University of Utah, 30 N 1900 E, Salt Lake City, UT 84132, USA
| | - Meenakshi Sigireddi
- Perlmutter Cancer Center, NYU Langone Health, 160 E. 34th Street, New York, NY 10016, USA
| | - Ophira Ginsburg
- Center for Global Health, National Cancer Institute, 9609 Medical Center Drive, Rockville, MD 20892-9760, USA
| | - Kimberly A Kaphingst
- Department of Communication, University of Utah, 255 S. Central Campus Drive, Salt Lake City, UT 84112, USA
- Huntsman Cancer Institute, 2000 Circle of Hope Drive, Salt Lake City, UT 84112, USA
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Wang C, Paasche-Orlow MK, Bowen DJ, Cabral H, Winter MR, Norkunas Cunningham T, Trevino-Talbot M, Toledo DM, Cortes DE, Campion M, Bickmore T. Utility of a virtual counselor (VICKY) to collect family health histories among vulnerable patient populations: A randomized controlled trial. PATIENT EDUCATION AND COUNSELING 2021; 104:979-988. [PMID: 33750594 PMCID: PMC8113103 DOI: 10.1016/j.pec.2021.02.034] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 01/25/2021] [Accepted: 02/16/2021] [Indexed: 05/29/2023]
Abstract
OBJECTIVES This study is a randomized controlled trial comparing the efficacy of a virtual counselor (VICKY) to the My Family Health Portrait (MFHP) tool for collecting family health history (FHx). METHODS A total of 279 participants were recruited from a large safety-net hospital and block randomized by health literacy to use one of the digital FHx tools, followed by a genetic counselor interview. A final sample of 273 participants were included for analyses of primary study aims pertaining to tool concordance, which assessed agreement between tool and genetic counselor. RESULTS Tool completion differed significantly between tools (VICKY = 97%, MFHP = 51%; p < .0001). Concordance between tool and genetic counselor was significantly greater for participants randomized to VICKY compared to MFHP for ascertaining first- and second-degree relatives (ps<.0001), and most health conditions examined. There was significant interaction by health literacy, with greater differences in concordance observed between tools among those with limited literacy. CONCLUSIONS A virtual counselor overcomes many of the literacy-related barriers to using traditional digital tools and highlights an approach that may be important to consider when collecting health histories from vulnerable populations. PRACTICE IMPLICATIONS The usability of digital health history tools will have important implications for the quality of the data collected and its downstream clinical utility.
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Affiliation(s)
- Catharine Wang
- Department of Community Health Sciences, Boston University School of Public Health, Boston, MA, USA.
| | - Michael K Paasche-Orlow
- Department of Medicine, Boston University School of Medicine and Boston Medical Center, Boston, MA, USA
| | - Deborah J Bowen
- Department of Bioethics and Humanities, School of Medicine, University of Washington, Seattle, WA, USA
| | - Howard Cabral
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA
| | - Michael R Winter
- Biostatistics and Epidemiology Data Analytics Center (BEDAC), Boston University School of Public Health, Boston, MA, USA
| | | | - Michelle Trevino-Talbot
- Department of Community Health Sciences, Boston University School of Public Health, Boston, MA, USA
| | - Diana M Toledo
- Department of Pathology and Laboratory Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | - Dharma E Cortes
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA; Health Equity Research Lab, Cambridge Health Alliance, Cambridge, MA, USA
| | - MaryAnn Campion
- Department of Genetics, Stanford University, Stanford, CA, USA
| | - Timothy Bickmore
- Khoury College of Computer Sciences, Northeastern University, Boston, MA, USA
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Orlando LA, Wu RR, Myers RA, Neuner J, McCarty C, Haller IV, Harry M, Fulda KG, Dimmock D, Rakhra-Burris T, Buchanan A, Ginsburg GS. At the intersection of precision medicine and population health: an implementation-effectiveness study of family health history based systematic risk assessment in primary care. BMC Health Serv Res 2020; 20:1015. [PMID: 33160339 PMCID: PMC7648301 DOI: 10.1186/s12913-020-05868-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Accepted: 10/27/2020] [Indexed: 01/27/2023] Open
Abstract
Background Risk assessment is a precision medicine technique that can be used to enhance population health when applied to prevention. Several barriers limit the uptake of risk assessment in health care systems; and little is known about the potential impact that adoption of systematic risk assessment for screening and prevention in the primary care population might have. Here we present results of a first of its kind multi-institutional study of a precision medicine tool for systematic risk assessment. Methods We undertook an implementation-effectiveness trial of systematic risk assessment of primary care patients in 19 primary care clinics at four geographically and culturally diverse healthcare systems. All adult English or Spanish speaking patients were invited to enter personal and family health history data into MeTree, a patient-facing family health history driven risk assessment program, for 27 medical conditions. Risk assessment recommendations followed evidence-based guidelines for identifying and managing those at increased disease risk. Results One thousand eight hundred eighty-nine participants completed MeTree, entering information on N = 25,967 individuals. Mean relatives entered = 13.7 (SD 7.9), range 7–74. N = 1443 (76.4%) participants received increased risk recommendations: 597 (31.6%) for monogenic hereditary conditions, 508 (26.9%) for familial-level risk, and 1056 (56.1%) for risk of a common chronic disease. There were 6617 recommendations given across the 1443 participants. In multivariate analysis, only the total number of relatives entered was significantly associated with receiving a recommendation. Conclusions A significant percentage of the general primary care population meet criteria for more intensive risk management. In particular 46% for monogenic hereditary and familial level disease risk. Adopting strategies to facilitate systematic risk assessment in primary care could have a significant impact on populations within the U.S. and even beyond. Trial registration Clinicaltrials.gov number NCT01956773, registered 10/8/2013.
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Affiliation(s)
- Lori A Orlando
- Department of Medicine, Center for Applied Genomics and Precision Medicine, Duke University School of Medicine, Durham, USA.
| | - R Ryanne Wu
- Department of Medicine, Center for Applied Genomics and Precision Medicine, Duke University School of Medicine, Durham, USA.,Programme in Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore
| | - Rachel A Myers
- Department of Medicine, Center for Applied Genomics and Precision Medicine, Duke University School of Medicine, Durham, USA
| | - Joan Neuner
- Department of Medicine, Medical College of Wisconsin, Milwaukee, USA.,Center for Patient Care and Outcomes Research, Medical College of Wisconsin, Milwaukee, USA
| | | | | | | | - Kimberly G Fulda
- The North Texas Primary care Practice-Based Research Network and Family Medicine, University of North Texas Health Science Center, Fort Worth, USA
| | - David Dimmock
- Rady Children's Institute for Genomic Medicine, San Diego, USA
| | - Teji Rakhra-Burris
- Department of Medicine, Center for Applied Genomics and Precision Medicine, Duke University School of Medicine, Durham, USA
| | - Adam Buchanan
- Genomic Medicine Institute, Geisinger, Geisinger, USA
| | - Geoffrey S Ginsburg
- Department of Medicine, Center for Applied Genomics and Precision Medicine, Duke University School of Medicine, Durham, USA
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5
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Papageorge MV, Resio BJ, Monsalve AF, Canavan M, Pathak R, Mase VJ, Dhanasopon AP, Hoag JR, Blasberg JD, Boffa DJ. Navigating by Stars: Using CMS Star Ratings to Choose Hospitals for Complex Cancer Surgery. JNCI Cancer Spectr 2020; 4:pkaa059. [PMID: 33134834 PMCID: PMC7583163 DOI: 10.1093/jncics/pkaa059] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2020] [Revised: 03/30/2020] [Accepted: 06/26/2020] [Indexed: 11/16/2022] Open
Abstract
Background The Centers for Medicare and Medicaid Services (CMS) developed risk-adjusted “Star Ratings,” which serve as a guide for patients to compare hospital quality (1 star = lowest, 5 stars = highest). Although star ratings are not based on surgical care, for many procedures, surgical outcomes are concordant with star ratings. In an effort to address variability in hospital mortality after complex cancer surgery, the use of CMS Star Ratings to identify the safest hospitals was evaluated. Methods Patients older than 65 years of age who underwent complex cancer surgery (lobectomy, colectomy, gastrectomy, esophagectomy, pancreaticoduodenectomy) were evaluated in CMS Medicare Provider Analysis and Review files (2013-2016). The impact of reassignment was modeled by applying adjusted mortality rates of patients treated at 5-star hospitals to those at 1-star hospitals (Peters-Belson method). Results There were 105 823 patients who underwent surgery at 3146 hospitals. The 90-day mortality decreased with increasing star rating (1 star = 10.4%, 95% confidence interval [CI] = 9.8% to 11.1%; and 5 stars = 6.4%, 95% CI = 6.0% to 6.8%). Reassignment of patients from 1-star to 5-star hospitals (7.8% of patients) was predicted to save 84 Medicare beneficiaries each year. This impact varied by procedure (colectomy = 47 lives per year; gastrectomy = 5 lives per year). Overall, 2189 patients would have to change hospitals each year to improve outcomes (26 patients moved to save 1 life). Conclusions Mortality after complex cancer surgery is associated with CMS Star Rating. However, the use of CMS Star Ratings by patients to identify the safest hospitals for cancer surgery would be relatively inefficient and of only modest impact.
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Affiliation(s)
- Marianna V Papageorge
- Section of Thoracic Surgery, Department of Surgery, Yale School of Medicine, New Haven, CT, USA
| | - Benjamin J Resio
- Section of Thoracic Surgery, Department of Surgery, Yale School of Medicine, New Haven, CT, USA
| | - Andres F Monsalve
- Section of Thoracic Surgery, Department of Surgery, Yale School of Medicine, New Haven, CT, USA
| | - Maureen Canavan
- Cancer Outcomes, Public Policy and Effectiveness Research Center, Yale School of Medicine, New Haven, CT, USA
| | - Ranjan Pathak
- Section of Thoracic Surgery, Department of Surgery, Yale School of Medicine, New Haven, CT, USA
| | - Vincent J Mase
- Section of Thoracic Surgery, Department of Surgery, Yale School of Medicine, New Haven, CT, USA
| | - Andrew P Dhanasopon
- Section of Thoracic Surgery, Department of Surgery, Yale School of Medicine, New Haven, CT, USA
| | - Jessica R Hoag
- Cancer Outcomes, Public Policy and Effectiveness Research Center, Yale School of Medicine, New Haven, CT, USA
| | - Justin D Blasberg
- Section of Thoracic Surgery, Department of Surgery, Yale School of Medicine, New Haven, CT, USA
| | - Daniel J Boffa
- Section of Thoracic Surgery, Department of Surgery, Yale School of Medicine, New Haven, CT, USA
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Rajaram A, Thomas D, Sallam F, Verma AA, Rawal S. Accuracy of the Preferred Language Field in the Electronic Health Records of Two Canadian Hospitals. Appl Clin Inform 2020; 11:644-649. [PMID: 32998169 DOI: 10.1055/s-0040-1715896] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
BACKGROUND The collection of race, ethnicity, and language (REaL) data from patients is advocated as a first step to identify, monitor, and improve health inequities. As a result, many health care institutions collect patients' preferred languages in their electronic health records (EHRs). These data may be used in clinical care, research, and quality improvement. However, the accuracy of EHR language data are rarely assessed. OBJECTIVES This study aimed to audit the accuracy of EHR language data at two academic hospitals in Toronto, Ontario, Canada. METHODS The EHR language was compared with a patient's stated preferred language by interview. Language was dichotomized to English or non-English. Agreement between language documented in the EHR and patient-reported preferred language was calculated using sensitivity, specificity, and positive predictive value (PPV). RESULTS A total of 323 patients were interviewed, including 96 with a stated non-English preferred language. The sensitivity of the EHR for English-language preference was high at both hospitals: 100% at hospital A with a PPV of 88%, and 99% at hospital B with a PPV of 85%. However, the sensitivity of the EHR for non-English preference differed greatly between the two hospitals. The sensitivity was 81% with a PPV of 100% at hospital A and the sensitivity was 12% with a PPV of 60% at hospital B. CONCLUSION The accuracy of the EHR for identifying non-English language preference differed greatly between the hospitals studied. Language data must be accurate for it to be used, and regular quality assurance is required.
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Affiliation(s)
- Akshay Rajaram
- Department of Family Medicine, Queen's University, Kingston, Ontario, Canada
| | - Daniel Thomas
- School of Medicine, University College Cork, Cork, Ireland
| | - Faten Sallam
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Amol A Verma
- Li Ka Shing Centre for Healthcare Analytics Research and Training and Division of General Internal Medicine, St. Michael's Hospital, Toronto, Ontario, Canada.,Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Shail Rawal
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada.,Division of General Internal Medicine, University Health Network, Toronto, Ontario, Canada
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Evaluation of family health history collection methods impact on data and risk assessment outcomes. Prev Med Rep 2020; 18:101072. [PMID: 32181122 PMCID: PMC7066218 DOI: 10.1016/j.pmedr.2020.101072] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Revised: 02/17/2020] [Accepted: 03/02/2020] [Indexed: 11/20/2022] Open
Abstract
Information technology applications for patient-collection of family health history (FHH) increase identification of elevated-risk individuals compared to usual care. It is unknown if the method of collection impacts data collected or if simply going directly to the patient is what makes the difference. The objective of this study was to examine differences in data detail and risk identification rates between FHH collection directly from individuals using paper-based forms and an interactive web-based platform. This is a non-randomized epidemiologic study in Singaporean population from 2016 to 2018. Intervention was paper-based versus web-based interactive platform for FHH collection. Participant demographics, FHH detail, and risk assessment results were analyzed. 882 participants enrolled in the study, 481 in the paper-based group and 401 in the web-based group with mean (SD) age of 45.4 (12.98) years and 47.5% male. Web-based FHH collection participants had an increased number of conditions per relative (p-value <0.001), greater frequency of reporting age of onset (p-value <0.001), and greater odds of receiving ≥1 risk recommendation both overall (OR: 3.99 (2.41, 6.59)) and within subcategories of genetic counselling for hereditary cancer syndromes (p-value = 0.041) and screening and prevention for breast (p-value = 0.002) and colon cancer (p-value = 0.005). This has significant implications for clinical care and research efforts where FHH is being assessed. Using interactive information technology platforms to collect FHH can improve the completeness of the data collected and result in increased rates of risk identification. Methods of data collection to maximize benefit should be taken into account in future studies and clinical care.
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