Lori A Orlando1,2, R Ryanne Wu1,2, Rachel A Myers1,2, Adam H Buchanan3, Vincent C Henrich4, Elizabeth R Hauser5, Geoffrey S Ginsburg1,2. 1. Duke Center for Applied Genomics & Precision Medicine, Duke University, Durham, North Carolina, USA. 2. Duke Department of Medicine, Duke University, Durham, North Carolina, USA. 3. Genomic Medicine Institute, Geisinger Health System, Danville, Pennsylvania, USA. 4. Center for Biotechnology, Genomics, and Health Research, University of North Carolina-Greensboro, Greensboro, North Carolina, USA. 5. Center for Human Genomics, Department of Medicine, Duke University and Epidemiological Research and Information Center, Durham VA Medical Center, Durham, North Carolina, USA.
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.Genet Med 18 10, 1020-1028.
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.Genet Med 18 10, 1020-1028.
Authors: Victor G Vogel; Joseph P Costantino; D Lawrence Wickerham; Walter M Cronin; Reena S Cecchini; James N Atkins; Therese B Bevers; Louis Fehrenbacher; Eduardo R Pajon; James L Wade; André Robidoux; Richard G Margolese; Joan James; Scott M Lippman; Carolyn D Runowicz; Patricia A Ganz; Steven E Reis; Worta McCaskill-Stevens; Leslie G Ford; V Craig Jordan; Norman Wolmark Journal: JAMA Date: 2006-06-05 Impact factor: 56.272
Authors: Paul A Harris; Robert Taylor; Robert Thielke; Jonathon Payne; Nathaniel Gonzalez; Jose G Conde Journal: J Biomed Inform Date: 2008-09-30 Impact factor: 6.317
Authors: Adam H Buchanan; Carol A Christianson; Tiffany Himmel; Karen P Powell; Astrid Agbaje; Geoffrey S Ginsburg; Vincent C Henrich; Lori A Orlando Journal: J Genet Couns Date: 2014-08-15 Impact factor: 2.537
Authors: Katrina F Trivers; Laura-Mae Baldwin; Jacqueline W Miller; Barbara Matthews; C Holly A Andrilla; Denise M Lishner; Barbara A Goff Journal: Cancer Date: 2011-07-25 Impact factor: 6.860
Authors: Chris A Beadles; R Ryanne Wu; Tiffany Himmel; Adam H Buchanan; Karen P Powell; Elizabeth Hauser; Vincent C Henrich; Geoffrey S Ginsburg; Lori A Orlando Journal: Fam Cancer Date: 2014-06 Impact factor: 2.375
Authors: Wendy S Rubinstein; Louise S Acheson; Suzanne M O'Neill; Mack T Ruffin; Catharine Wang; Jennifer L Beaumont; Nan Rothrock Journal: Genet Med Date: 2011-11 Impact factor: 8.822
Authors: R Ryanne Wu; Lori A Orlando; Tiffany L Himmel; Adam H Buchanan; Karen P Powell; Elizabeth R Hauser; Astrid B Agbaje; Vincent C Henrich; Geoffrey S Ginsburg Journal: BMC Fam Pract Date: 2013-08-06 Impact factor: 2.497
Authors: Tara Schmidlen; Amy C Sturm; Shelly Hovick; Laura Scheinfeldt; J Scott Roberts; Lindsey Morr; Joseph McElroy; Amanda E Toland; Michael Christman; Julianne M O'Daniel; Erynn S Gordon; Barbara A Bernhardt; Kelly E Ormond; Kevin Sweet Journal: J Genet Couns Date: 2018-02-19 Impact factor: 2.537
Authors: Teri A Manolio; Robb Rowley; Marc S Williams; Dan Roden; Geoffrey S Ginsburg; Carol Bult; Rex L Chisholm; Patricia A Deverka; Howard L McLeod; George A Mensah; Mary V Relling; Laura Lyman Rodriguez; Cecelia Tamburro; Eric D Green Journal: Lancet Date: 2019-08-05 Impact factor: 79.321
Authors: R Ryanne Wu; Rachel A Myers; Adam H Buchanan; David Dimmock; Kimberly G Fulda; Irina V Haller; Susanne B Haga; Melissa L Harry; Catherine McCarty; Joan Neuner; Teji Rakhra-Burris; Nina Sperber; Corrine I Voils; Geoffrey S Ginsburg; Lori A Orlando Journal: Appl Clin Inform Date: 2019-03-13 Impact factor: 2.342
Authors: Agnes Sebastian; June C Carroll; Leslie E Oldfield; Chloe Mighton; Salma Shickh; Elizabeth Uleryk; Yvonne Bombard Journal: Genet Med Date: 2021-01-08 Impact factor: 8.822