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

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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.

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Acknowledgements

Contributors

We thank all of the clinicians, staff, and patients at the primary care practices who participated in the study.

Funders

This study was supported by grants from the CRICO/Risk Management Foundation of the Harvard Medical Institutions and from the National Human Genome Research Institute (1RC1HG005331). Dr. Baer also was supported by a Mentored Research Scientist Career Development Award from the Agency for Healthcare Research and Quality (K01HS019789).

Prior Presentations

Some of this manuscript was presented as a poster at the annual meeting of the Society of General Internal Medicine in Orlando, Florida, in May 2012.

Conflict of Interest

The creators and owners of Your Health Snapshot (Dr. Graham Colditz and Mr. Hank Dart, at Washington University School of Medicine) collaborated on some aspects of the study design and are included as co-authors on the paper. However, the authors had no financial relationship with them and they did not have access to the data or participate in the statistical analyses.

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Authors and Affiliations

  1. Division of General Internal Medicine and Primary Care, Brigham and Women’s Hospital, 1620 Tremont Street, Boston, MA, 02120, USA

    Heather J. Baer SD, Louise I. Schneider MD, Analisa Andry SM, Deborah H. Williams MHA, E. John Orav PhD, Jennifer S. Haas MD, MSPH, Elizabeth Whittemore MSW, MPH & David W. Bates MD, MSc

  2. Harvard Medical School, Boston, MA, USA

    Heather J. Baer SD, Louise I. Schneider MD, E. John Orav PhD, Jennifer S. Haas MD, MSPH & David W. Bates MD, MSc

  3. Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA

    Heather J. Baer SD

  4. Alvin J. Siteman Cancer Center and Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA

    Graham A. Colditz MD, DrPH & Hank Dart SM

  5. Department of Biostatistics, Harvard School of Public Health, Boston, MA, USA

    E. John Orav PhD

  6. Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, MA, USA

    Jennifer S. Haas MD, MSPH

  7. Partners HealthCare, Boston, MA, USA

    George Getty BS & David W. Bates MD, MSc

  8. Department of Health Policy and Management, Harvard School of Public Health, Boston, MA, USA

    David W. Bates MD, MSc

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  1. Heather J. Baer SD
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  2. Louise I. Schneider MD
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  3. Graham A. Colditz MD, DrPH
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  4. Hank Dart SM
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  5. Analisa Andry SM
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  8. Jennifer S. Haas MD, MSPH
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  10. Elizabeth Whittemore MSW, MPH
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  11. David W. Bates MD, MSc
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Corresponding author

Correspondence to Heather J. Baer SD.

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Baer, H.J., Schneider, L.I., Colditz, G.A. et al. Use of a Web-based Risk Appraisal Tool for Assessing Family History and Lifestyle Factors in Primary Care. J GEN INTERN MED 28, 817–824 (2013). https://doi.org/10.1007/s11606-013-2338-z

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  • DOI: https://doi.org/10.1007/s11606-013-2338-z

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