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.
A type III hybrid implementation-effectiveness trial. Uptake and implementation processes were evaluated using the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework.
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.
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.
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This study was funded by National Institutes of Health (NIH) grant no. 1 U01 HG007282. The funder had no involvement in the design, conduct, data collection, analysis, or manuscript preparation. Corrine Voils’ effort on this study was supported by a Research Career Scientist award from the Department of Veterans Affairs (RCS 14-443). This study was approved by the institutional review boards of all four participating institutions and the funders. The views are those of the authors and do not reflect the Department of Veterans Affairs or United States Government.
Drs. Wu, Orlando, and Ginsburg have a potential conflict of interest. They recently formed a company, MeTree&You, that will provide MeTree as a clinical service. The other authors declare no conflicts of interest.
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Wu, R.R., Myers, R.A., Sperber, N. et al. Implementation, adoption, and utility of family health history risk assessment in diverse care settings: evaluating implementation processes and impact with an implementation framework. Genet Med 21, 331–338 (2019) doi:10.1038/s41436-018-0049-x
- Risk assessment
- Population health
- Family history
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