Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, 1620 Tremont Street, Boston, MA 02120, USA.
J Gen Intern Med. 2013 Jun;28(6):817-24. doi: 10.1007/s11606-013-2338-z. Epub 2013 Jan 31.
Primary care clinicians can play an important role in identifying individuals at increased risk of cancer, but often do not obtain detailed information on family history or lifestyle factors from their patients.
We evaluated the feasibility and effectiveness of using a web-based risk appraisal tool in the primary care setting.
Five primary care practices within an academic care network were assigned to the intervention or control group.
We included 15,495 patients who had a new patient visit or annual exam during an 8-month period in 2010-2011.
Intervention patients were asked to complete a web-based risk appraisal tool on a laptop computer immediately before their visit. Information on family history of cancer was sent to their electronic health record (EHR) for clinicians to view; if accepted, it populated coded fields and could trigger clinician reminders about colon and breast cancer screening.
The main outcome measure was new documentation of a positive family history of cancer in coded EHR fields. Secondary outcomes included clinician reminders about screening and discussion of family history, lifestyle factors, and screening.
Among eligible intervention patients, 2.0% had new information on family history of cancer entered in the EHR within 30 days after the visit, compared to 0.6% of eligible control patients (adjusted odds ratio = 4.3, p = 0.03). There were no significant differences in the percent of patients who received moderate or high risk reminders for colon or breast cancer screening.
Use of this tool was associated with increased documentation of family history of cancer in the EHR, although the percentage of patients with new family history information was low in both groups. Further research is needed to determine how risk appraisal tools can be integrated with workflow and how they affect screening and health behaviors.
初级保健临床医生在识别癌症风险增加的个体方面可以发挥重要作用,但他们通常无法从患者那里获得详细的家族史或生活方式因素信息。
我们评估了在初级保健环境中使用基于网络的风险评估工具的可行性和有效性。
在一个学术护理网络内的五家初级保健诊所被分配到干预组或对照组。
我们纳入了 2010 年至 2011 年 8 个月期间有新患者就诊或年度体检的 15495 名患者。
干预组患者在就诊前被要求在膝上型计算机上完成基于网络的风险评估工具。有关癌症家族史的信息被发送到他们的电子健康记录(EHR)供临床医生查看;如果被接受,它将填充编码字段,并可能触发临床医生对结肠癌和乳腺癌筛查的提醒。
主要结局是在编码的 EHR 字段中记录新的阳性癌症家族史。次要结局包括关于筛查的临床医生提醒以及关于家族史、生活方式因素和筛查的讨论。
在符合条件的干预组患者中,有 2.0%的患者在就诊后 30 天内 EHR 中输入了有关癌症家族史的新信息,而符合条件的对照组患者中则为 0.6%(调整后的优势比=4.3,p=0.03)。两组患者接受结肠癌或乳腺癌筛查中度或高度风险提醒的比例均无显著差异。
使用该工具与 EHR 中癌症家族史记录的增加相关,尽管两组患者中具有新家族史信息的患者比例均较低。需要进一步研究如何将风险评估工具与工作流程相结合,以及它们如何影响筛查和健康行为。