title: Patient and primary care provider experience using a family health history collection, risk stratification, and clinical decision support tool: a type 2 hybrid controlled implementation-effectiveness trial.
abstract: BACKGROUND
  Family health history (FHH) is the single strongest predictor of disease risk and yet is significantly underutilized in primary care. We developed a patient facing FHH collection tool, MeTree, that uses risk stratification to generate clinical decision support for breast cancer, colorectal cancer, ovarian cancer, hereditary cancer syndromes, and thrombosis. Here we present data on the experience of patients and providers after integration of MeTree into 2 primary care practices.
  
  
  METHODS
  This was a Type 2 hybrid controlled implementation-effectiveness study in 3 community-based primary care clinics in Greensboro, NC. All non-adopted adult English speaking patients with upcoming routine appointments were invited. Patients were recruited from December 2009 to the present and followed for one year. Ease of integration of MeTree into clinical practice at the two intervention clinics was evaluated through patient surveys after their appointment and at 3 months post-visit, and physician surveys 3 months after tool integration.
  
  
  RESULTS
  Total enrollment =1,184. Average time to complete MeTree = 27 minutes. Patients found MeTree: easy to use (93%), easy to understand (97%), useful (98%), raised awareness of disease risk (85%), and changed how they think about their health (86%). Of the 26% (N = 311) asking for assistance to complete the tool, age (65 sd 9.4 vs. 57 sd 11.8, p-value < 0.00) and large pedigree size (24.4 sd 9.81 vs. 22.2 sd 8.30, p-value < 0.00) were the only significant factors; 77% of those requiring assistance were over the age of 60. Providers (N = 14) found MeTree: improved their practice (86%), improved their understanding of FHH (64%), made practice easier (79%), and worthy of recommending to their peers (93%).
  
  
  CONCLUSIONS
  Our study shows that MeTree has broad acceptance and support from both patients and providers and can be implemented without disruption to workflow.
authors.affiliation: Health Services Research and Development, VA Health System, Durham, NC, USA. ryanne.wu@duke.edu.
authors.forename: R Ryanne
authors.initials: RR
authors.lastname: Wu
authors.forename: Lori A
authors.initials: LA
authors.lastname: Orlando
authors.forename: Tiffany L
authors.initials: TL
authors.lastname: Himmel
authors.forename: Adam H
authors.initials: AH
authors.lastname: Buchanan
authors.forename: Karen P
authors.initials: KP
authors.lastname: Powell
authors.forename: Elizabeth R
authors.initials: ER
authors.lastname: Hauser
authors.forename: Astrid B
authors.initials: AB
authors.lastname: Agbaje
authors.forename: Vincent C
authors.initials: VC
authors.lastname: Henrich
authors.forename: Geoffrey S
authors.initials: GS
authors.lastname: Ginsburg
mesh_terms: D000368:Aged; D001291:Attitude of Health Personnel; D001943:Breast Neoplasms / Q000235:genetics / Q000517:prevention & control; D015179:Colorectal Neoplasms / Q000235:genetics / Q000517:prevention & control; D020000:Decision Support Systems, Clinical; D003936:Diagnosis, Computer-Assisted / Q000379:methods; D055088:Early Detection of Cancer / Q000379:methods; D005190:Family; D005260:Female; D020022:Genetic Predisposition to Disease; D006801:Humans; D008297:Male; D008487:Medical History Taking / Q000379:methods*; D008875:Middle Aged; D009369:Neoplasms / Q000235:genetics / Q000517:prevention & control*; D009386:Neoplastic Syndromes, Hereditary / Q000235:genetics / Q000517:prevention & control; D010051:Ovarian Neoplasms / Q000235:genetics / Q000517:prevention & control; D010342:Patient Acceptance of Health Care; D011320:Primary Health Care / Q000379:methods*; D018570:Risk Assessment / Q000379:methods; D013927:Thrombosis / Q000235:genetics / Q000517:prevention & control*
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