title: Development and validation of a primary care-based family health history and decision support program (MeTree).
abstract: BACKGROUND
  Family health history is a strong predictor of disease risk. To reduce the morbidity and mortality of many chronic diseases, risk-stratified evidence-based guidelines strongly encourage the collection and synthesis of family health history to guide selection of primary prevention strategies. However, the collection and synthesis of such information is not well integrated into clinical practice. To address barriers to collection and use of family health histories, the Genomedical Connection developed and validated MeTree, a Web-based, patient-facing family health history collection and clinical decision support tool. MeTree is designed for integration into primary care practices as part of the genomic medicine model for primary care.
  
  
  METHODS
  We describe the guiding principles, operational characteristics, algorithm development, and coding used to develop MeTree. Validation was performed through stakeholder cognitive interviewing, a genetic counseling pilot program, and clinical practice pilot programs in 2 community-based primary care clinics.
  
  
  RESULTS
  Stakeholder feedback resulted in changes to MeTree's interface and changes to the phrasing of clinical decision support documents. The pilot studies resulted in the identification and correction of coding errors and the reformatting of clinical decision support documents. MeTree's strengths in comparison with other tools are its seamless integration into clinical practice and its provision of action-oriented recommendations guided by providers' needs.
  
  
  CONCLUSIONS
  The tool was validated in a small cohort.
  
  
  CONCLUSIONS
  MeTree can be integrated into primary care practices to help providers collect and synthesize family health history information from patients with the goal of improving adherence to risk-stratified evidence-based guidelines.
authors.affiliation: Department of Medicine, Duke University, Durham, North Carolina 27705, USA. lorlando@duke.edu
authors.forename: Lori A
authors.initials: LA
authors.lastname: Orlando
authors.forename: Adam H
authors.initials: AH
authors.lastname: Buchanan
authors.forename: Susan E
authors.initials: SE
authors.lastname: Hahn
authors.forename: Carol A
authors.initials: CA
authors.lastname: Christianson
authors.forename: Karen P
authors.initials: KP
authors.lastname: Powell
authors.forename: Celette Sugg
authors.initials: CS
authors.lastname: Skinner
authors.forename: Blair
authors.initials: B
authors.lastname: Chesnut
authors.forename: Colette
authors.initials: C
authors.lastname: Blach
authors.forename: Barbara
authors.initials: B
authors.lastname: Due
authors.forename: Geoffrey S
authors.initials: GS
authors.lastname: Ginsburg
authors.forename: Vincent C
authors.initials: VC
authors.lastname: Henrich
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002908:Chronic Disease / Q000517:prevention & control*; D003625:Data Collection / Q000379:methods; D020000:Decision Support Systems, Clinical; D005190:Family; D005260:Female; D006801:Humans; D020407:Internet; D008297:Male; D008487:Medical History Taking / Q000379:methods*; D008875:Middle Aged; D011320:Primary Health Care; D018570:Risk Assessment; D055815:Young Adult
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