Use of a web-based risk appraisal tool for assessing family history and lifestyle factors in primary care.
BACKGROUND
Primary care clinicians can play an important role in identifying individuals at increased risk of cancer, but often do not obtain detailed information on family history or lifestyle factors from their patients.


OBJECTIVE
We evaluated the feasibility and effectiveness of using a web-based risk appraisal tool in the primary care setting.


METHODS
Five primary care practices within an academic care network were assigned to the intervention or control group.


METHODS
We included 15,495 patients who had a new patient visit or annual exam during an 8-month period in 2010-2011.


METHODS
Intervention patients were asked to complete a web-based risk appraisal tool on a laptop computer immediately before their visit. Information on family history of cancer was sent to their electronic health record (EHR) for clinicians to view; if accepted, it populated coded fields and could trigger clinician reminders about colon and breast cancer screening.


METHODS
The main outcome measure was new documentation of a positive family history of cancer in coded EHR fields. Secondary outcomes included clinician reminders about screening and discussion of family history, lifestyle factors, and screening.


RESULTS
Among eligible intervention patients, 2.0% had new information on family history of cancer entered in the EHR within 30 days after the visit, compared to 0.6% of eligible control patients (adjusted odds ratio = 4.3, p = 0.03). There were no significant differences in the percent of patients who received moderate or high risk reminders for colon or breast cancer screening.


CONCLUSIONS
Use of this tool was associated with increased documentation of family history of cancer in the EHR, although the percentage of patients with new family history information was low in both groups. Further research is needed to determine how risk appraisal tools can be integrated with workflow and how they affect screening and health behaviors.
Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, 1620 Tremont Street, Boston, MA 02120, USA. hbaer@partners.org
Heather J
HJ
Baer
Louise I
LI
Schneider
Graham A
GA
Colditz
Hank
H
Dart
Analisa
A
Andry
Deborah H
DH
Williams
E John
EJ
Orav
Jennifer S
JS
Haas
George
G
Getty
Elizabeth
E
Whittemore
David W
DW
Bates
D000328:Adult; D000368:Aged; D055088:Early Detection of Cancer / Q000379:methods; D057286:Electronic Health Records; D005240:Feasibility Studies; D005260:Female; D020022:Genetic Predisposition to Disease; D006801:Humans; D020407:Internet; D008019:Life Style; D008297:Male; D008404:Massachusetts; D008487:Medical History Taking / Q000379:methods; D008875:Middle Aged; D009369:Neoplasms / Q000209:etiology* / Q000235:genetics; D011320:Primary Health Care / Q000379:methods*; D018570:Risk Assessment / Q000379:methods; D055815:Young Adult