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Implementing family health history risk stratification in primary care: impact of guideline criteria on populations and resource demand.

Publication ,  Journal Article
Orlando, LA; Wu, RR; Beadles, C; Himmel, T; Buchanan, AH; Powell, KP; Hauser, ER; Henrich, VC; Ginsburg, GS
Published in: Am J Med Genet C Semin Med Genet
March 2014

UNLABELLED: The Genomic Medicine Model aims to facilitate patient engagement, patient/provider education of genomics/personalized medicine, and uptake of risk-stratified evidence-based prevention guidelines using MeTree, a patient-facing family health history (FHH) collection and clinical decision support (CDS) program. Here we report the number of increased risk (above population-level risk) patients identified for breast/ovarian cancer, colon cancer, hereditary syndrome risk, and thrombosis; the prevalence of FHH elements triggering increased-risk status; and the resources needed to manage their risk. STUDY DESIGN: hybrid implementation-effectiveness study of adults with upcoming well-visits in 2 primary care practices in Greensboro, NC. PARTICIPANTS: 1,184, mean age = 58.8, female = 58% (N = 694), non-white = 20% (N = 215). Increased Risk: 44% (N = 523). RECOMMENDATIONS: genetic counseling = 26% (N = 308), breast MRI = 0.8% (N = 10), breast chemoprophylaxis = 5% (N = 58), early/frequent colonoscopies = 19% (N = 221), ovarian cancer screening referral = 1% (N = 14), thrombosis testing/counseling = 2.4% (N = 71). FHH elements: 8 FHH elements lead to 37.3% of the increased risk categorizations (by frequency): first-degree-relative (FDR) with polyps age ≥60 (7.1%, N = 85), three relatives with Lynch-related cancers (5.4%, N = 65), FDR with polyps age <60 (5.1%, N = 61), three relatives on same side of family with same cancer (4.9%, N = 59), Gail score ≥1.66% (4.9%, N = 58), two relatives with breast cancer (one ≤age 50) (4.1%, N = 49), one relative with breast cancer ≤age 40 (4.1%, N = 48), FDR with colon cancer age ≥60 (1.7%, N = 20). MeTree identifies a high percentage of individuals in the general primary care population needing non-routine risk management/prevention for the selected conditions. Implementing risk-stratification in primary care will likely increase demand for related-resources, particularly colon screening and GC. Understanding the prevalence of FHH elements helps predict resource needs and may aid in guideline development.

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Published In

Am J Med Genet C Semin Med Genet

DOI

EISSN

1552-4876

Publication Date

March 2014

Volume

166C

Issue

1

Start / End Page

24 / 33

Location

United States

Related Subject Headings

  • Thrombosis
  • Risk Assessment
  • Primary Health Care
  • Precision Medicine
  • North Carolina
  • Neoplasms
  • Medical History Taking
  • Humans
  • Genetics, Medical
  • Genetics & Heredity
 

Citation

APA
Chicago
ICMJE
MLA
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Orlando, L. A., Wu, R. R., Beadles, C., Himmel, T., Buchanan, A. H., Powell, K. P., … Ginsburg, G. S. (2014). Implementing family health history risk stratification in primary care: impact of guideline criteria on populations and resource demand. Am J Med Genet C Semin Med Genet, 166C(1), 24–33. https://doi.org/10.1002/ajmg.c.31388
Orlando, Lori A., R Ryanne Wu, Chris Beadles, Tiffany Himmel, Adam H. Buchanan, Karen P. Powell, Elizabeth R. Hauser, Vincent C. Henrich, and Geoffrey S. Ginsburg. “Implementing family health history risk stratification in primary care: impact of guideline criteria on populations and resource demand.Am J Med Genet C Semin Med Genet 166C, no. 1 (March 2014): 24–33. https://doi.org/10.1002/ajmg.c.31388.
Orlando LA, Wu RR, Beadles C, Himmel T, Buchanan AH, Powell KP, et al. Implementing family health history risk stratification in primary care: impact of guideline criteria on populations and resource demand. Am J Med Genet C Semin Med Genet. 2014 Mar;166C(1):24–33.
Orlando, Lori A., et al. “Implementing family health history risk stratification in primary care: impact of guideline criteria on populations and resource demand.Am J Med Genet C Semin Med Genet, vol. 166C, no. 1, Mar. 2014, pp. 24–33. Pubmed, doi:10.1002/ajmg.c.31388.
Orlando LA, Wu RR, Beadles C, Himmel T, Buchanan AH, Powell KP, Hauser ER, Henrich VC, Ginsburg GS. Implementing family health history risk stratification in primary care: impact of guideline criteria on populations and resource demand. Am J Med Genet C Semin Med Genet. 2014 Mar;166C(1):24–33.
Journal cover image

Published In

Am J Med Genet C Semin Med Genet

DOI

EISSN

1552-4876

Publication Date

March 2014

Volume

166C

Issue

1

Start / End Page

24 / 33

Location

United States

Related Subject Headings

  • Thrombosis
  • Risk Assessment
  • Primary Health Care
  • Precision Medicine
  • North Carolina
  • Neoplasms
  • Medical History Taking
  • Humans
  • Genetics, Medical
  • Genetics & Heredity