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Implementation, Adoption, and Utility of Family History in Diverse Care Settings

The purpose of this study is to address the key question of whether and how family health history (FHH) is adopted as a tool to more efficiently manage patients at risk for breast, colon, ovarian, and hereditary cancer syndromes as well as thrombophilia and coronary heart disease (CHD) and to provide evidence supporting clinical utility -- improved health behaviors in patients and physician screening recommendations. Five health care delivery organizations will participate in this demonstration project: Duke University, the Medical College of Wisconsin, the Air Force, Essentia Health, University of North Texas. Duke will serve as a coordinating center for this project (Pro00043372) as well as a site. Healthcare Effectiveness Data and Information Set (HEDIS) measures as intermediate clinical effectiveness measures for Coronary Heart Disease (CHD) and selected cancers as well as survey/formative data and electronic medical record (EMR) data will be used as outcomes measures. The research model is purposely designed to mimic clinical delivery as an important step toward widespread implementation and sustainability. In addition, a cost-effectiveness analysis comparing usual care to the FHH guided preventive health model will be used. The completion of this project will result in an optimal strategy for integration of FHH data collection and clinical decision support (CDS) tools into an EMR and demonstrate the utility of the FHH intervention among diverse primary care patients, their settings, their providers, and the health systems that deliver their care.

Specific Aim 1: To optimize the collection of patient entered FHH in diverse clinical environments for coronary heart disease, thrombosis, and selected cancers

Specific Aim 2: To export FHH data to an open clinical decision support (open CDS) platform and return CDS results to providers and patients (and to EMRs where relevant). To explore the integration of genetic risk and FHH data at selected sites.

Specific Aim 3: To assess the clinical and personal utility of FHH using a pragmatic observational study design to assess reach, adoption, integrity, exposure, and sustainability, and to capture, analyze, and report effectiveness outcomes at each stakeholder level: patient, provider, and clinic/system.

Specific Aim 4: To take a leadership role in the dissemination of guidelines for a FHH intervention across in diverse practice settings.

AAA
Hypertension
Lupus
Multiple sclerosis
Obesity
Osteoporosis
Thyroid disease
Rheumatoid arthritis
Blood clotting (6):

Brain Disorders (5): Cancer/Adenomas (32): Cardiovascular/heart/artery disease (5): Diabetes (3): Digestive Disorders (5): Eye Disorder (3): Hereditary Cancer Syndromes (22): Hereditary Cardiovascular syndromes (10): High cholesterol (2): Kidney Disease (6): Liver Disease (6): Lung Disease (3): Psychological disorder (14): Sickle cell/thalassemia (3): Thalassemia