Journal Article

Clinical utility of a Web-enabled risk-assessment and clinical decision support program

March 03, 2016

Clinical utility of a Web-enabled risk-assessment and clinical decision support program. March 3, 2016. Genetics in Medicine. Lori A. Orlando MD, MHS, R. Ryanne Wu MD, Rachel A. Myers PhD, Adam H. Buchanan MS, MPH, Vincent C. Henrich PhD, Elizabeth R. Hauser PhD & Geoffrey S. Ginsburg MD, PhD.

Author Affiliations

Duke Center for Applied Genomics & Precision Medicine, Duke University, Durham, North Carolina, USA
Lori A. Orlando, R. Ryanne Wu, Rachel A. Myers & Geoffrey S. Ginsburg

Duke Department of Medicine, Duke University, Durham, North Carolina, USA
Lori A. Orlando, R. Ryanne Wu, Rachel A. Myers & Geoffrey S. Ginsburg

Genomic Medicine Institute, Geisinger Health System, Danville, Pennsylvania, USA
Adam H. Buchanan

Center for Biotechnology, Genomics, and Health Research, University of North Carolina–Greensboro, Greensboro, North Carolina, USA
Vincent C. Henrich

Center for Human Genomics, Department of Medicine, Duke University and Epidemiological Research and Information Center, Durham VA Medical Center, Durham, North Carolina, USA
Elizabeth R. Hauser

Abstract

Purpose:
Risk-stratified guidelines can improve quality of care and cost-effectiveness, but their uptake in primary care has been limited. MeTree, a Web-based, patient-facing risk-assessment and clinical decision support tool, is designed to facilitate uptake of risk-stratified guidelines.

Methods:
A hybrid implementation-effectiveness trial of three clinics (two intervention, one control). Participants: consentable nonadopted adults with upcoming appointments. Primary outcome: agreement between patient risk level and risk management for those meeting evidence-based criteria for increased-risk risk-management strategies (increased risk) and those who do not (average risk) before MeTree and after. Measures: chart abstraction was used to identify risk management related to colon, breast, and ovarian cancer, hereditary cancer, and thrombosis.

Results:
Participants = 488, female = 284 (58.2%), white = 411 (85.7%), mean age = 58.7 (SD = 12.3). Agreement between risk management and risk level for all conditions for each participant, except for colon cancer, which was limited to those <50 years of age, was (i) 1.1% (N = 2/174) for the increased-risk group before MeTree and 16.1% (N = 28/174) after and (ii) 99.2% (N = 2,125/2,142) for the average-risk group before MeTree and 99.5% (N = 2,131/2,142) after. Of those receiving increased-risk risk-management strategies at baseline, 10.5% (N = 2/19) met criteria for increased risk. After MeTree, 80.7% (N = 46/57) met criteria. Conclusion: MeTree integration into primary care can improve uptake of risk-stratified guidelines and potentially reduce “overuse” and “underuse” of increased-risk services.

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