Health IT Enhanced Family Health History Documentation & Management in Primary Ca

描述（由申请人提供）：越来越多的证据和对几种常见慢性疾病的遗传成分的理解，导致有关家庭健康史信息的重要性增加，并将这些信息与其他常见疾病的风险因素（如生活方式风险因素）相结合。美国预防服务工作组（USPSTF）建议使用家族健康史作为常见疾病的常规遗传筛查测试，因为获得完整的家族健康史是确定需要干预（例如，强化筛查，改变生活方式，预防性治疗和遗传咨询）的患者的第一步。随着我们对基因组的理解不断发展，将家族健康史与个人医疗记录相结合的重要性将会增加，因为将详细的个人遗传信息纳入临床环境将变得更加重要。由于一次典型的初级保健访问的时间有限，以及初级保健提供者（pcp）对其评估和提供风险指导的自我效能感的担忧，pcp通常不获得家庭健康史或提供个性化的风险评估。这些问题突出表明，需要利用技术来独立于诊所访问收集这些数据，同时使这些数据与个人的电子健康记录（EHR）互操作。电话交互式语音应答系统（IVRS）和自我管理的基于网络的工具是一种低成本、可持续的接触初级保健人群的方式，无需访问。我们建议开发、实施和评估一个病人报告的、电子病历集成的个性化风险评估模块，以提供量身定制的疾病风险和风险降低信息。拟议项目的具体目标是：目标1：开发一个患者报告的、ehr集成的个性化风险评估模块，为患者及其PCP提供针对四种常见疾病（乳腺癌、结直肠癌、冠心病和II型糖尿病）的量身定制的疾病风险和降低风险的信息。目标2：通过对布里格姆和妇女初级保健实践研究网络的成人初级保健患者进行集群随机对照试验（RCT），测量该综合风险评估模块的覆盖范围和有效性。目标3：评价采用和实施这一综合风险评估模块的促进因素和障碍。该项目将进一步加深我们对如何利用技术来填补当前临床实践中的空白的理解，通过促进系统收集家庭健康史和生活方式风险因素数据，并将这些数据与个人电子病历相结合，在各种环境和不同患者群体中实现个性化护理。这项工作将使用当前的国家数据标准来实现互操作性，从该项目中吸取的经验教训将输出到美国各地的医疗保健机构。

DESCRIPTION (provided by applicant): Growing evidence and understanding of an inherited component to several common, chronic diseases has led to an increase in the importance of information about family health history, and the integration of this information with other risk factors for common diseases, like lifestyle risk factors. The US Preventive Services Task Force (USPSTF) recommends the use of family health history as a routine genetic screening test for common diseases, as obtaining a complete family health history is the first step to identifying patients who are in need of intervention (e.g., intensive screening, lifestyle modification, preventative therapies, and genetic counseling). The importance of integrating family health history with an individual's medical record will increase as our understanding of the genome evolves because it will be more essential to put detailed personal genetic information into a clinical context. Because of limited time during a typical primary care visit, and the concerns of primary care providers (PCPs) about their self-efficacy of estimating and providing guidance about risk, PCPs frequently do not obtain a family health history or provide individualized risk assessment. These issues highlight the need to leverage technology to collect these data independent of clinic visits, yet have these data interoperate with an individual's electronic health record (EHR). Telephonic interactive voice response systems (IVRS) and self-administered web-based tools are a low-cost, sustainable way of reaching out to primary care populations, independent of a visit. We propose to develop, implement, and evaluate a patient-reported, EHR- integrated personalized risk assessment module to provide tailored disease risk and risk reduction information. The Specific Aims of the proposed project are to: Aim 1: Develop a patient-reported, EHR-integrated, personalized risk assessment module to provide tailored disease risk and risk reduction information for four common diseases (breast cancer, colorectal cancer, coronary heart disease, and type II diabetes) for the patient and his/ her PCP. Aim 2: Measure the reach and effectiveness of this integrated risk assessment module by conducting a cluster randomized controlled trial (RCT) of adult primary care patients in the Brigham and Women's Primary Care Practice-Based Research Network. Aim 3: Evaluate facilitators and barriers to the adoption and implementation of this integrated risk assessment module. This project will further our understanding of how technology can be used to fill a gap in current clinical practice by facilitating the systematic collection of family health history and lifestyle risk factor data and integrating these data with an individual's EHR to personalize care in a variety of settings and for diverse patient populations. This work will use current national data standards for interoperability, and lessons learned from this project will be exportable to healthcare settings throughout the United States.