Clinical utility of a Web-enabled risk-assessment and clinical decision support program.
Journal Article (Journal Article)
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.Genet Med 18 10, 1020-1028.
Full Text
Duke Authors
- Ginsburg, Geoffrey Steven
- Hauser, Elizabeth Rebecca
- Myers, Rachel
- Orlando, Lori Ann
- Wu, Rebekah Ryanne
Cited Authors
- Orlando, LA; Wu, RR; Myers, RA; Buchanan, AH; Henrich, VC; Hauser, ER; Ginsburg, GS
Published Date
- October 2016
Published In
Volume / Issue
- 18 / 10
Start / End Page
- 1020 - 1028
PubMed ID
- 26938783
Electronic International Standard Serial Number (EISSN)
- 1530-0366
Digital Object Identifier (DOI)
- 10.1038/gim.2015.210
Language
- eng
Conference Location
- United States