Original Reserach

Journal of General Internal Medicine

, Volume 28, Issue 6, pp 817-824

Use of a Web-based Risk Appraisal Tool for Assessing Family History and Lifestyle Factors in Primary Care

  • Heather J. BaerAffiliated withDivision of General Internal Medicine and Primary Care, Brigham and Women’s HospitalHarvard Medical SchoolDepartment of Epidemiology, Harvard School of Public Health Email author 
  • , Louise I. SchneiderAffiliated withDivision of General Internal Medicine and Primary Care, Brigham and Women’s HospitalHarvard Medical School
  • , Graham A. ColditzAffiliated withAlvin J. Siteman Cancer Center and Department of Surgery, Washington University School of Medicine
  • , Hank DartAffiliated withAlvin J. Siteman Cancer Center and Department of Surgery, Washington University School of Medicine
  • , Analisa AndryAffiliated withDivision of General Internal Medicine and Primary Care, Brigham and Women’s Hospital
  • , Deborah H. WilliamsAffiliated withDivision of General Internal Medicine and Primary Care, Brigham and Women’s Hospital
  • , E. John OravAffiliated withDivision of General Internal Medicine and Primary Care, Brigham and Women’s HospitalHarvard Medical SchoolDepartment of Biostatistics, Harvard School of Public Health
  • , Jennifer S. HaasAffiliated withDivision of General Internal Medicine and Primary Care, Brigham and Women’s HospitalHarvard Medical SchoolDepartment of Social and Behavioral Sciences, Harvard School of Public Health
  • , George GettyAffiliated withPartners HealthCare
    • , Elizabeth WhittemoreAffiliated withDivision of General Internal Medicine and Primary Care, Brigham and Women’s Hospital
    • , David W. BatesAffiliated withDivision of General Internal Medicine and Primary Care, Brigham and Women’s HospitalHarvard Medical SchoolPartners HealthCareDepartment of Health Policy and Management, Harvard School of Public Health

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ABSTRACT

BACKGROUND

Primary care clinicians can play an important role in identifying individuals at increased risk of cancer, but often do not obtain detailed information on family history or lifestyle factors from their patients.

OBJECTIVE

We evaluated the feasibility and effectiveness of using a web-based risk appraisal tool in the primary care setting.

DESIGN

Five primary care practices within an academic care network were assigned to the intervention or control group.

PARTICIPANTS

We included 15,495 patients who had a new patient visit or annual exam during an 8-month period in 2010–2011.

INTERVENTION

Intervention patients were asked to complete a web-based risk appraisal tool on a laptop computer immediately before their visit. Information on family history of cancer was sent to their electronic health record (EHR) for clinicians to view; if accepted, it populated coded fields and could trigger clinician reminders about colon and breast cancer screening.

MAIN MEASURES

The main outcome measure was new documentation of a positive family history of cancer in coded EHR fields. Secondary outcomes included clinician reminders about screening and discussion of family history, lifestyle factors, and screening.

KEY RESULTS

Among eligible intervention patients, 2.0 % had new information on family history of cancer entered in the EHR within 30 days after the visit, compared to 0.6 % of eligible control patients (adjusted odds ratio = 4.3, p = 0.03). There were no significant differences in the percent of patients who received moderate or high risk reminders for colon or breast cancer screening.

CONCLUSIONS

Use of this tool was associated with increased documentation of family history of cancer in the EHR, although the percentage of patients with new family history information was low in both groups. Further research is needed to determine how risk appraisal tools can be integrated with workflow and how they affect screening and health behaviors.

KEY WORDS

risk appraisal family history cancer primary care