Health Information Technology Enhanced Family Health History Documentation & Management in Primary Care (Massachusetts)

Project Final Report (PDF, 483.35 KB) Disclaimer

Project Details - Ended

Project Categories

Summary:

Family health history and an individual’s lifestyle are known contributors to risk of developing chronic diseases such as diabetes, heart disease, and cancer. Assessing this information in a systematic way may facilitate early identification of patients at greatest risk, and promote informed decisionmaking by patients and communication with their health care providers. Effective use of health risk appraisals (HRAs) by patients in primary care settings may promote accurate risk assessment, motivate health promotion and behavior change, and facilitate population management.

The widespread deployment and meaningful use of electronic health records (EHRs) offers an opportunity to systematically integrate HRAs with EHRs with the ability to create customized decision support and recommendations for primary prevention and screening. This project reported on Patient Risk Evaluation and Prevention (PREP), a study which systematically collected family health history and lifestyle risk factors from primary care patients, and produced a personalized HRA.

The specific aims of the project were as follow:

  • To develop a patient-reported, EHR-integrated, personalized risk assessment module to provide tailored disease risk and risk reduction information for these four common conditions for the patient and their primary care physician. 
  • To measure the reach and effectiveness of this integrated risk assessment module by conducting a cluster randomized controlled trial (RCT) of adult primary care patients in the Brigham and Women’s Primary Care Practice-Based Research Network. 
  • To evaluate facilitators and barriers to the adoption and implementation. 

PREP was a pragmatic cluster RCT where pre-visit intervention patients completed an assessment of their family history, lifestyle, and risk perception, and received a personalized HRA to discuss with their doctor. Post-visit, intervention patients received an assessment that included just the risk perception questions to re-assess accuracy of self-perceived risk. The same information was collected from the control patients but in the reverse order so that no information was available for the visit.

Results from the study found that pre-visit use of a multi-condition EHR-integrated HRA in primary care has the potential to modestly improve patient-provider communication about risk and changes that can be made to improve health. Patient understanding of personal health risks were also improved by linking patient-provided information with the health care team and providing personalized education, reminders, and health tips.

Health Information Technology Enhanced Family Health History Documentation & Management in Primary Care - 2012

Summary Highlights

  • Principal Investigator: 
  • Funding Mechanism: 
    PAR: HS08-270: Utilizing Health Information Technology to Improve Health Care Quality Grant (R18)
  • Grant Number: 
    R18 HS 018644
  • Project Period: 
    September 2011 - July 2014
  • AHRQ Funding Amount: 
    $1,111,483
  • PDF Version: 
    (PDF, 175.97 KB)

Summary: Increased understanding of genetic and hereditary components of disease has increased the importance of information about family history in patient medical records. However, it is very difficult for providers to get full family histories and make individual risk assessments during short primary care visits. Technology has the potential to improve providers’ ability to capture this information and estimate and provide guidance on health risks based upon it. This project is developing two methods of collecting family health history as part of an integrated risk assessment module: 1) a telephonic interactive voice response system (IVRS) that uses a computer to detect voice during a normal phone call and encourages patients to provide their history through programmed questions; and 2) a Web-based tool with a series of questions. Patients will choose their preferred method and information gathered will be incorporated into the patient’s electronic health record (EHR). Based on reported family history, a computer server will summarize information into a risk assessment for patient and provider discussion. This will be paired with assessment-based clinical decision support reminders to providers.

The integrated risk assessment module will be evaluated through a cluster randomized controlled trial of adult primary care patients in the Brigham and Women’s Primary Care Practice-Based Research Network (PBRN). The evaluation of this project will assess the ability of the module to reach a large number of patients, its effectiveness in improving personalized risk assessment and counseling, and the facilitators and barriers of adoption and implementation. The findings from this research will increase understanding about how technology can improve collection of family health history information from diverse populations and be used to provide personalized risk assessment.

Specific Aims:

  • Develop a patient-reported, EHR-integrated, personalized risk assessment module to provide tailored disease risk and risk reduction information for four common conditions (breast cancer, colorectal cancer, coronary heart disease, and type II diabetes) for the patient and his or her primary care physician (PCP). (Ongoing)
  • Measure the reach and effectiveness of this integrated risk assessment module by conducting a cluster randomized controlled trial of adult primary care patients in the Brigham and Women’s Primary Care Practice-Based Research Network. (Upcoming)
  • Evaluate facilitators and barriers to the adoption and implementation. (Upcoming)

2012 Activities: The research team identified 13 practices to recruit patients to test the integrated risk assessment module. The complex structuring of the family history component required the team to find a skilled vendor with sophisticated voice technology. The risk assessment tool was created to incorporate both patient-reported family health history and lifestyle risk factors into a single tool. This will provide tailored disease risk and risk reduction information for the patient and PCP. In developing the tool, which is based on an algorithm developed at Washington University, the team reviewed literature on the metrics associated with lifestyle risk factors. Dr. Haas modified the tool to provide a risk score and calculation using the fewest possible data points so that only the most heavily weighted data elements are collected. This will allow them to keep the phone survey as short as possible to maintain the patients’ attention.

The IVRS script was piloted and revised based on that pilot testing. Four different scripts were finalized and will be automated for the randomized controlled trial. Both study arms have pre- and post-visit scripts, which have also been translated into Spanish.

The format and mechanism for delivering the final risk assessment report to participating patients has been designed. Patient risk reports will be available to patients through an online personal health record or through the mail. Physicians will have access through the medical record. For the trial design, the intervention group will get the report 2 weeks before their visit. The hope is that this will stimulate discussion between the patient and provider. Patients in the control group will receive their reports after their visits.

The research team developed the post-surveys that will ask patients if they used the risk assessment data during their medical appointment and whether the physician talked with them and answered questions about the risk report. The development of a physician survey was also completed. This survey will measure self-efficacy for individualized risk assessment, patient counseling about personalized risk, and perceived barriers and facilitators to these activities in the primary care setting.

Dr. Hass worked with the IVRS vendor to revise, refine, and record the scripts for the telephone survey and develop modified versions for implementation as a Web survey that will interface with patient portal accounts. The pilot of the risk assessment in the IVRS identified quality problems with the system. Dr. Haas worked with the vendor to use live calls to support the IVRS system. The team created the protocol and tools necessary for data storing and data sharing throughout the period of data collection.

As last self-reported in the AHRQ Research Reporting System, project progress and activities are on track and project spending is on target.

Preliminary Impact and Findings: This project has no findings to date.

Target Population: Adults

Strategic Goal: Develop and disseminate health IT evidence and evidence-based tools to improve health care decisionmaking through the use of integrated data and knowledge management.

Business Goal: Knowledge Creation

Health IT Enhanced Family Health History Documentation & Management in Primary Care - 2011

Summary Highlights

  • Principal Investigator: 
  • Funding Mechanism: 
    PAR: HS08-270: Utilizing Health Information Technology (IT) to Improve Health Care Quality (R18)
  • Grant Number: 
    R18 HS 018644
  • Project Period: 
    September 2011 - July 2014
  • AHRQ Funding Amount: 
    $1,111,483
  • PDF Version: 
    (PDF, 191.3 KB)

Summary: The growing understanding of the genetic and hereditary components to disease has increased the importance of information about family history as a component of a patient medical record. However, in the context of short primary care visits, full family histories accompanied by individual risk assessment are challenging for providers. Technology has the potential to improve the ability of providers to both capture this type of information and to estimate and provide guidance on health risks based on family history. This project is developing two methods to collect family health history as part of an integrated risk assessment module: 1) a telephonic interactive voice response system (IVRS) that uses a computer to detect voice during a normal phone call and encourages patients to provide their history through programmed questions; and 2) a Web-based tool with a series of questions. Patients will choose their preferred method and information gathered will be incorporated into the patient electronic health record (EHR). Based on reported family history, a computer server will summarize information into a risk assessment for patient and provider discussion. This will be paired with clinical decision support reminders to providers based on the assessment.

The integrated risk assessment module will be evaluated through a cluster randomized controlled trial of adult primary care patients in the Brigham and Women's Primary Care Practice-Based Research Network. The evaluation of this project will assess the ability of the module to reach a large number of patients, its effectiveness in improving personalized risk assessment and counseling, and the facilitators and barriers of adoption and implementation. The findings from this research will increase understanding about how technology can be used to improve collection of family health history information from diverse populations and be used to provide personalized risk assessment.

Specific Aims:

  • Develop a patient-reported, EHR-integrated, personalized risk assessment module to provide tailored disease risk and risk reduction information for these four common conditions (breast cancer, colorectal cancer, coronary heart disease, and type II diabetes) for the patient and his/her primary care physician (PCP). (Ongoing)
  • Measure the reach and effectiveness of this integrated risk assessment module by conducting a cluster randomized controlled trial of adult primary care patients in the Brigham and Women's Primary Care Practice-Based Research Network. (Upcoming)
  • Evaluate facilitators and barriers to the adoption and implementation. (Upcoming)

2011 Activities: The research team began developing a risk assessment tool to incorporate both patient-reported family health history and lifestyle risk factors into a single tool to provide tailored disease risk and risk reduction information for the patient and PCP. An IVRS script and Web-based version of a risk assessment tool is being created based on Your Health Snapshot and the Surgeon General's My Family Health Portrait that will run on a secure site behind the health system's firewall. The IVRS and Web-based risk assessment surveys are being augmented through a literature review of metrics associated with lifestyle risk factors for the targeted diseases/conditions. For physicians, the team is developing a survey to measure self-efficacy for individualized risk assessment and patient counseling about personalized risk, and perceived barriers and facilitators to these activities in the primary care setting. The provider survey will be distributed at the end of the intervention to get feedback on the risk assessment tool. The team is developing a survey for patients to measure their personal assessment of risk for breast cancer, colon cancer, heart disease, and diabetes and the process of care for preventing these conditions.

There are two study arms. One consists of patients who will complete their history through robocalls and the integrated voice response; the other is patients who will complete their history through a personal health record. The research team is currently developing the tools and surveys to be used through each arm. The team has expanded the disease categories to include ovarian, prostate, endometrial, and lung cancer and is finalizing the risk assessment module of self-reported family health history and personal risk factors. The goal is to use these in a randomized control trial across Partners HealthCare primary care clinics. There are 16 clinics affiliated with the Brigham and Women's Hospital and the scheme is to have eight control clinics.

As last self-reported in the AHRQ Research Reporting System, project progress and activities are on track and project spending is on target.

Preliminary Impact and Findings: This project has no findings to date.

Target Population: Adults

Strategic Goal: Develop and disseminate health IT evidence and evidence-based tools to improve health care decisionmaking through the use of integrated data and knowledge management.

Business Goal: Knowledge Creation

Health Information Technology Enhanced Family Health History Documentation & Management in Primary Care - Final Report

Citation:
Haas J. Health Information Technology Enhanced Family Health History Documentation & Management in Primary Care - Final Report. (Prepared by Brigham and Women's Hospital under Grant No. R18 HS018644). Rockville, MD: Agency for Healthcare Research and Quality, 2016. (PDF, 483.35 KB)

The findings and conclusions in this document are those of the author(s), who are responsible for its content, and do not necessarily represent the views of AHRQ. No statement in this report should be construed as an official position of AHRQ or of the U.S. Department of Health and Human Services.
Principal Investigator: 
Document Type: 
Population: 

PREP Intervention: IVRS Scripts for Pre- and Post- Visit Surveys

PDF: PREP Intervention: IVRS Scripts for Pre- and Post- Visit Surveys (PDF, 359.02 KB)
This project does not have any related survey.
This project does not have any related project spotlight.
This project does not have any related survey.
This project does not have any related story.
This project does not have any related emerging lesson.