Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford MSOB, 1265 Welch Rd x216, Palo Alto, CA, 94305, USA.
BMC Fam Pract. 2021 Feb 2;22(1):28. doi: 10.1186/s12875-021-01373-4.
Humanwide was precision health embedded in primary care aiming to leverage high-tech and high-touch medicine to promote wellness, predict and prevent illness, and tailor treatment to individual medical and psychosocial needs.
We conducted a study assessing implementation outcomes to inform spread and scale, using mixed methods of semi-structured interviews with diverse stakeholders and chart reviews. Humanwide included: 1) health coaching; 2) four digital health tools for blood-pressure, weight, glucose, and activity; 3) pharmacogenomic testing; and 4) genetic screening/testing. We examined implementation science constructs: reach/penetration, acceptability, feasibility, and sustainability. Chart reviews captured preliminary clinical outcomes.
Fifty of 69 patients (72%) invited by primary care providers participated in the Humanwide pilot. We performed chart reviews for the 50 participating patients. Participants were diverse overall (50% non-white, 66% female). Over half of the participants were obese and 58% had one or more major cardiovascular risk factor: dyslipidemia, hypertension, diabetes. Reach/penetration of Humanwide components varied: pharmacogenomics testing 94%, health coaching 80%, genetic testing 72%, and digital health 64%. Interview participants (n=27) included patients (n=16), providers (n=9), and the 2 staff who were allocated dedicated time for Humanwide patient intake and orientation. Patients and providers reported Humanwide was acceptable; it engaged patients holistically, supported faster medication titration, and strengthened patient-provider relationships. All patients benefited clinically from at least one Humanwide component. Feasibility challenges included: low provider self-efficacy for interpreting genetics and pharmacogenomics; difficulties with data integration; patient technology challenges; and additional staffing needs. Patient financial burden concerns surfaced with respect to sustainability.
This is the first report of implementation of a multi-component precision health model embedded in team-based primary care. We found acceptance from both patients and providers; however, feasibility barriers must be overcome to enable broad spread and sustainability. We found that barriers to implementation of precision health in a team-based primary care clinic are mundane and straightforward, though not necessarily easy to overcome. Future implementation endeavors should invest in basics: education, workflow, and reflection/evaluation. Strengthening fundamentals will enable healthcare systems to more nimbly accept the responsibility of meeting patients at the crossroads of innovative science and routinized clinical systems.
Humanwide 将精准健康嵌入基层医疗，旨在利用高科技和高接触式医疗来促进健康、预测和预防疾病，并根据个人的医疗和社会心理需求定制治疗方案。
我们采用半结构化访谈和图表审查相结合的方法，对不同利益相关者进行了一项评估实施结果以促进推广和扩大规模的研究。Humanwide 包括：1）健康指导；2）四个用于血压、体重、血糖和活动的数字健康工具；3）药物基因组学检测；4）基因筛查/检测。我们研究了实施科学的构建：覆盖范围/渗透率、可接受性、可行性和可持续性。图表审查记录了初步的临床结果。
在基层医疗提供者邀请的 69 名患者中，有 50 名（72%）参加了 Humanwide 试点。我们对 50 名参与患者进行了图表审查。参与者总体上是多样化的（50%是非白人，66%是女性）。超过一半的参与者肥胖，58%有一个或多个主要心血管危险因素：血脂异常、高血压、糖尿病。Humanwide 各组成部分的覆盖范围/渗透率不同：药物基因组学检测 94%，健康指导 80%，基因检测 72%，数字健康 64%。参与访谈的人员（n=27）包括患者（n=16）、提供者（n=9），以及两名被分配专门时间用于 Humanwide 患者接待和定向的员工。患者和提供者报告称 Humanwide 是可以接受的；它全面地吸引了患者，支持更快的药物滴定，并加强了医患关系。所有患者都从至少一个 Humanwide 组成部分中受益。可行性挑战包括：提供者解读遗传学和药物基因组学的自我效能感低；数据集成困难；患者技术挑战；以及额外的人员配备需求。可持续性方面出现了患者经济负担的担忧。
这是第一个报告将多组件精准健康模型嵌入团队式基层医疗的实施情况。我们发现患者和提供者都接受了它；然而，为了实现广泛推广和可持续性，必须克服可行性障碍。我们发现，团队式基层医疗诊所实施精准健康的障碍是平凡而直接的，尽管不一定容易克服。未来的实施工作应该投资于基础知识：教育、工作流程和反思/评估。加强基础将使医疗保健系统能够更灵活地承担起在创新科学和常规临床系统的十字路口满足患者需求的责任。
