Evaluation of a Novel Electronic Genetic Screening and Clinical Decision Support Tool in Prenatal Clinical Settings
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“The Pregnancy and Health Profile” (PHP) is a free prenatal genetic screening and clinical decision support (CDS) software tool for prenatal providers. PHP collects family health history (FHH) during intake and provides point-of-care risk assessment for providers and education for patients. This pilot study evaluated patient and provider responses to PHP and effects of using PHP in practice. PHP was implemented in four clinics. Surveys assessed provider confidence and knowledge and patient and provider satisfaction with PHP. Data on the implementation process were obtained through semi-structured interviews with administrators. Quantitative survey data were analyzed using Chi square test, Fisher’s exact test, paired t tests, and multivariate logistic regression. Open-ended survey questions and interviews were analyzed using qualitative thematic analysis. Of the 83 % (513/618) of patients that provided feedback, 97 % felt PHP was easy to use and 98 % easy to understand. Thirty percent (21/71) of participating physicians completed both pre- and post-implementation feedback surveys [13 obstetricians (OBs) and 8 family medicine physicians (FPs)]. Confidence in managing genetic risks significantly improved for OBs on 2/6 measures (p values ≤0.001) but not for FPs. Physician knowledge did not significantly change. Providers reported value in added patient engagement and reported mixed feedback about the CDS report. We identified key steps, resources, and staff support required to implement PHP in a clinical setting. To our knowledge, this study is the first to report on the integration of patient-completed, electronically captured and CDS-enabled FHH software into primary prenatal practice. PHP is acceptable to patients and providers. Key to successful implementation in the future will be customization options and interoperability with electronic health records.
KeywordsFamily health history Personalized risk assessment Clinical decision support Prenatal care Genetic screening
The Pregnancy and Health Profile was developed by the National Coalition for Health Professional Education in Genetics, Genetic Alliance, HughesRiskApps.net, the March of Dimes, and the Health Resources and Services Administration (HRSA) and is funded by Grant #U33MC12786 from HRSA. The views expressed in this publication are solely the opinions of the authors and do not necessarily reflect the official policies of the US Department of Health and Human Services or the Health Resources and Services Administration, nor does mention of the department or agency names imply endorsement by the US government. We are grateful to the women, providers, and clinic staff that participated in this project, especially the study coordinators and investigators from our collaborating clinical sites for their effort and continued partnership. We also acknowledge the project’s national advisory committee for members’ advice and time, and Joseph McInerney, Michele Lloyd Puryear, and Penny Kyler for their leadership and vision at early stages of this project.
- 8.ACOG. (2012). Practice bulletin: Clinical management guidelines for obstetrician-gynecologists. http://www.acog.org/~/media/List%20of%20Titles/PBListOfTitles.pdf.
- 11.SACGHS. (2011). Genetics education and training: Report of the secretary’s advisory committee on genetics, health, and society. Bethesda, MD: Department of Health and Human Services.Google Scholar
- 16.Welch, B. M., & Kawamoto, K. (2013). Clinical decision support for genetically guided personalized medicine: A systematic review. Journal of the American Medical Informatics Association, 20(2), 388–400.Google Scholar
- 20.NCHPEG. (2013). The pregnancy and health profile: A screening and risk assessment tool. Accessed July 15, 2013, from http://www.nchpeg.org/index.php?option=com_content&view=article&id=410&Itemid=277.
- 25.ACOG. (2013). ACOG Resource Center. Accessed February 4, 2013, from fromhttp://www.acog.org/About_ACOG/ACOG_Departments/Resource_Center.
- 31.Bauer, N. S., & Carroll, A. E. (2013). Downs SM. Journal of the American Medical Informatics Association: Understanding the acceptability of a computer decision support system in pediatric primary care.Google Scholar
- 34.Qureshi, N., Armstrong, S., Dhiman, P., et al. (2012). Effect of adding systematic family history enquiry to cardiovascular disease risk assessment in primary care. Annals of Internal Medicine, 156(4), 253–262.Google Scholar
- 35.NIH. (2009). Family history and improving health. National Institutes of Health State of the Science Consensus Conference; Bethesda, Maryland.Google Scholar