title: A Cluster Randomized Trial of a Personalized Multi-Condition Risk Assessment in Primary Care.
abstract: BACKGROUND
  Personal risk for multiple conditions should be assessed in primary care. This study evaluated whether collection of risk factors to generate electronic health record (EHR)-linked health risk appraisal (HRA) for coronary heart disease, diabetes, breast cancer, and colorectal cancer was associated with improved patient-provider communication, risk assessment, and plans for breast cancer screening.
  
  
  METHODS
  This pragmatic trial recruited adults with upcoming visits to 11 primary care practices during 2013-2014 (N=3,703). Pre-visit, intervention patients completed a risk factor and perception assessment and received an HRA; coded risk factor data were sent to the EHR. Post-visit, intervention patients reported risk perception. Pre-visit, control patients only completed the risk perception assessment; post-visit they also completed the risk factor assessment and received the HRA. No data were sent to the EHR for controls. Accuracy/improvement of self-perceived risk was assessed by comparing self-perceived to calculated risk.
  
  
  RESULTS
  The intervention was associated with improvement of patient-provider communication of changes to improve health (78.5% vs 74.1%, AOR=1.67, 99% CI=1.07, 2.60). There was a similar trend for discussion of risk (54.1% vs 45.5%, AOR=1.34, 95% CI=0.97, 1.85). The intervention was associated with greater improvement in accuracy of self-perceived risk for diabetes (16.0% vs 12.6%, p=0.006) and colorectal cancer (27.9% vs 17.2%, p<0.001) with a similar trend for coronary heart disease and breast cancer. There were no changes in plans for breast cancer screening.
  
  
  CONCLUSIONS
  Patient-reported risk factors and EHR-linked multi-condition HRAs in primary care can modestly improve communication and promote accuracy of self-perceived risk.
authors.affiliation: Division of General Medicine and Primary Care, Brigham and Women's Hospital, Boston, Massachusetts; Department of Medicine, Harvard University Medical School, Boston, Massachusetts; Department of Social and Behavioral Sciences, Harvard University School of Public Health, Boston, Massachusetts. Electronic address: jhaas@partners.org.
authors.forename: Jennifer S
authors.initials: JS
authors.lastname: Haas
authors.affiliation: Division of General Medicine and Primary Care, Brigham and Women's Hospital, Boston, Massachusetts; Department of Medicine, Harvard University Medical School, Boston, Massachusetts; Department of Epidemiology, Harvard University School of Public Health, Boston, Massachusetts.
authors.forename: Heather J
authors.initials: HJ
authors.lastname: Baer
authors.affiliation: Division of General Medicine and Primary Care, Brigham and Women's Hospital, Boston, Massachusetts.
authors.forename: Katyuska
authors.initials: K
authors.lastname: Eibensteiner
authors.affiliation: Division of General Medicine and Primary Care, Brigham and Women's Hospital, Boston, Massachusetts.
authors.forename: Elissa V
authors.initials: EV
authors.lastname: Klinger
authors.affiliation: Division of General Medicine and Primary Care, Brigham and Women's Hospital, Boston, Massachusetts.
authors.forename: Stella
authors.initials: S
authors.lastname: St Hubert
authors.affiliation: Division of General Medicine and Primary Care, Brigham and Women's Hospital, Boston, Massachusetts.
authors.forename: George
authors.initials: G
authors.lastname: Getty
authors.affiliation: Division of General Medicine and Primary Care, Brigham and Women's Hospital, Boston, Massachusetts.
authors.forename: Phyllis
authors.initials: P
authors.lastname: Brawarsky
authors.affiliation: Division of General Medicine and Primary Care, Brigham and Women's Hospital, Boston, Massachusetts; Department of Medicine, Harvard University Medical School, Boston, Massachusetts; Department of Biostatistics, Harvard University School of Public Health, Boston, Massachusetts.
authors.forename: E John
authors.initials: EJ
authors.lastname: Orav
authors.affiliation: Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth and Norris Cotton Cancer Center, Lebanon, New Hampshire.
authors.forename: Tracy
authors.initials: T
authors.lastname: Onega
authors.affiliation: Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth and Norris Cotton Cancer Center, Lebanon, New Hampshire.
authors.forename: Anna N A
authors.initials: AN
authors.lastname: Tosteson
authors.affiliation: Division of General Medicine and Primary Care, Brigham and Women's Hospital, Boston, Massachusetts; Department of Medicine, Harvard University Medical School, Boston, Massachusetts; Department of Health Policy and Management, Harvard University School of Public Health, Boston, Massachusetts.
authors.forename: David W
authors.initials: DW
authors.lastname: Bates
authors.affiliation: Institute for Public Health, Washington University School of Medicine, St. Louis, Missouri.
authors.forename: Graham
authors.initials: G
authors.lastname: Colditz
mesh_terms: D000328:Adult; D000368:Aged; D057286:Electronic Health Records; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D057285:Precision Medicine; D011320:Primary Health Care / Q000379:methods*; D018570:Risk Assessment / Q000379:methods*