Format

Send to

Choose Destination
Genet Med. 2018 Jun 6. doi: 10.1038/s41436-018-0049-x. [Epub ahead of print]

Implementation, adoption, and utility of family health history risk assessment in diverse care settings: evaluating implementation processes and impact with an implementation framework.

Author information

1
Center for Applied Genomics and Precision Medicine, Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA. Ryanne.wu@duke.edu.
2
Programme in Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore. Ryanne.wu@duke.edu.
3
Center for Applied Genomics and Precision Medicine, Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA.
4
Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina, USA.
5
Durham VA Health Services Research & Development Service, Durham, North Carolina, USA.
6
William S. Middleton Memorial Veterans Hospital, Madison, Wisconsin, USA.
7
Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA.
8
Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA.
9
Center for Patient Care and Outcomes Research, Medical College of Wisconsin, Milwaukee, Wisconsin, USA.
10
University of Minnesota Medical School, Duluth campus, Minneapolis, Minnesota, USA.
11
Essentia Institute of Rural Health, Duluth, Minnesota, USA.
12
The North Texas Primary care Practice-Based Research Network and Family Medicine, University of North Texas Health Science Center, Fort Worth, Texas, USA.
13
Graduate School of Biomedical Sciences, University of North Texas Health Science Center, Fort Worth, Texas, USA.
14
Rady Children's Institute for Genomic Medicine, Encinitas, California, USA.
15
Genomic Medicine Institute, Geisinger, Danville, Pennsylvania, USA.

Abstract

PURPOSE:

This paper describes the implementation outcomes associated with integrating a family health history-based risk assessment and clinical decision support platform within primary care clinics at four diverse healthcare systems.

METHODS:

A type III hybrid implementation-effectiveness trial. Uptake and implementation processes were evaluated using the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework.

RESULTS:

One hundred (58%) primary care providers and 2514 (7.8%) adult patients enrolled. Enrolled patients were 69% female, 22% minority, and 32% Medicare/Medicaid. Compared with their respective clinic's population, patient-participants were more likely to be female (69 vs. 59%), older (mean age 57 vs. 49), and Caucasian (88 vs. 69%) (all p values <0.001). Female (81.3% of females vs. 78.5% of males, p value = 0.018) and Caucasian (Caucasians 90.4% vs. minority 84.1%, p value = 0.02) patient-participants were more likely to complete the study once enrolled. Patient-participant survey responses indicated MeTree was easy to use (95%), and patient-participants would recommend it to family/friends (91%). Minorities and those with less education reported greatest benefit. Enrolled providers reflected demographics of underlying provider population.

CONCLUSION:

Family health history-based risk assessment can be effectively implemented in diverse primary care settings and can effectively engage patients and providers. Future research should focus on finding better ways to engage young adults, males, and minorities in preventive healthcare.

KEYWORDS:

Family history; Implementation; Population health; Risk assessment

Supplemental Content

Full text links

Icon for Nature Publishing Group Icon for PubMed Central
Loading ...
Support Center