Clinical utility of a Web-enabled risk-assessment and clinical decision support program

Abstract

Purpose: Risk-stratified guidelines can improve quality of care and cost-effectiveness, but their uptake in primary care has been limited. MeTree, a Web-based, patient-facing risk-assessment and clinical decision support tool, is designed to facilitate uptake of risk-stratified guidelines. Methods:A hybrid implementation-effectiveness trial of three clinics (two intervention, one control). Participants: consentable nonadopted adults with upcoming appointments. Primary outcome: agreement between patient risk level and risk management for those meeting evidence-based criteria for increased-risk risk-management strategies (increased risk) and those who do not (average risk) before MeTree and after. Measures: chart abstraction was used to identify risk management related to colon, breast, and ovarian cancer, hereditary cancer, and thrombosis.Results: Participants = 488, female = 284 (58.2%), white = 411 (85.7%), mean age = 58.7 (SD = 12.3). Agreement between risk management and risk level for all conditions for each participant, except for colon cancer, which was limited to those <50 years of age, was (i) 1.1% (N = 2/174) for the increased-risk group before MeTree and 16.1% (N = 28/174) after and (ii) 99.2% (N = 2,125/2,142) for the average-risk group before MeTree and 99.5% (N = 2,131/2,142) after. Of those receiving increased-risk risk-management strategies at baseline, 10.5% (N = 2/19) met criteria for increased risk. After MeTree, 80.7% (N = 46/57) met criteria. Conclusion:MeTree integration into primary care can improve uptake of risk-stratified guidelines and potentially reduce "overuse" and "underuse" of increased-risk services.

Effect of Sociodemographic Factors on Uptake of a Patient-Facing Information Technology Family Health History Risk Assessment Platform

“…[12][13][14][15] Numerous IT risk assessment tools (e.g., Family Healthware, Health Heritage) have been developed and have been shown to: improve the quality of FHH collected as compared with usual care, 7,16,17 increase the identification of at-risk individuals, 7,18,19 and impact health care practices of clinicians and patients. 20,21 One of these tools, MeTree, is a web-based, patient-facing FHH risk assessment platform with guidelineinformed clinical decision support that was developed by our group. 22 Little work has been done to evaluate the impact of patient demographics on the ability to complete FHH risk assessment tools.…”

Genetic cancer risk assessment in general practice: systematic review of tools available, clinician attitudes, and patient outcomes

“…Fourteen of these were cross-sectional studies, 2,20-32 two were retrospective studies, 15,33 and six were qualitative 4,9,[34][35][36][37] (of which four involved semi-structured interviews 4,34,35,37 ). There were 13 intervention studies, [38][39][40][41][42][43][44][45][46][47][48][49][50] comprising three validation studies, 38,47,50 one beforeafter study, 49 three hybrid implementation studies, 42,45,48 one comparison against standard care, 40 two comparative studies, 41,44 and three observational studies. 39,43,46 Three studies were cluster RCTs [51][52][53] and two were descriptive feasibility studies.…”

“…54,55 Populations studied All studies involved both male and female patients or their GPs, except for one, 35 which comprised only female patients and female practitioners. Fourteen studies were carried out in the UK, 2,4,[20][21][22]25,34,41,44,[49][50][51]54,55 17 in North America, 9,15,23,[27][28][29][30][31]35,37,39,42,43,45,48,52,53 two in South America, 38,47 and two in Australia. 33,36 The remaining four were conducted in the European Union 26,32,40,46 (the Netherlands, Belgium, and Spain), and one study reported data from four countries across Europe, 24 namely the UK, France, Germany, and the Netherlands.…”

“…A variety of tools that could be used in general practice for screening genetic cancer risk was desc ribed. 15,29,30,38,39,[42][43][44][45][47][48][49][50][52][53][54][55] Examples of family-history collection tools included Family Healthware, 52,53 a self-administered web-based tool, and the seven-item Family History Screen (FHS-7) tool, 38 both of which cover family history of breast, ovarian, and colorectal cancer. MeTree -a computerised tool stratifying risk of hereditary cancer syndromes (that is, breast, ovarian, and colorectal cancer) to be completed at routine visits and to support clinical decisionswas used in three studies.…”

How Online Family History Tool Design and Message Content Impact User Perceptions: An Examination of Family Health<b><i>Link</i></b>

“…Online and computerized family history tools administered in both public [1, 5, 7, 20-22] and clinic-based [23-27] settings are shown to have clinical benefits, particularly in terms of identifying at-risk individuals and familial health risks and in reducing clinician burden [28, 29]. Additionally, family health history tool use is shown to appropriately increase risk perceptions for CHD, diabetes, and colorectal cancer among those at higher risk [30, 31] and to increase general risk awareness [32].…”