Abstract
BackgroundRisk assessment is a precision medicine technique that can be used to enhance population health when applied to prevention. Several barriers limit the uptake of risk assessment in health care systems; and little is known about the potential impact that adoption of systematic risk assessment for screening and prevention in the primary care population might have. Here we present results of a first of its kind multi-institutional study of a precision medicine tool for systematic risk assessment.MethodsWe undertook an implementation-effectiveness trial of systematic risk assessment of primary care patients in 19 primary care clinics at four geographically and culturally diverse healthcare systems. All adult English or Spanish speaking patients were invited to enter personal and family health history data into MeTree, a patient-facing family health history driven risk assessment program, for 27 medical conditions. Risk assessment recommendations followed evidence-based guidelines for identifying and managing those at increased disease risk.ResultsOne thousand eight hundred eighty-nine participants completed MeTree, entering information on N = 25,967 individuals. Mean relatives entered = 13.7 (SD 7.9), range 7–74. N = 1443 (76.4%) participants received increased risk recommendations: 597 (31.6%) for monogenic hereditary conditions, 508 (26.9%) for familial-level risk, and 1056 (56.1%) for risk of a common chronic disease. There were 6617 recommendations given across the 1443 participants. In multivariate analysis, only the total number of relatives entered was significantly associated with receiving a recommendation.ConclusionsA significant percentage of the general primary care population meet criteria for more intensive risk management. In particular 46% for monogenic hereditary and familial level disease risk. Adopting strategies to facilitate systematic risk assessment in primary care could have a significant impact on populations within the U.S. and even beyond.Trial registrationClinicaltrials.gov number NCT01956773, registered 10/8/2013.
Highlights
Risk assessment is a precision medicine technique that can be used to enhance population health when applied to prevention
Population health is an increasingly important concept in U.S healthcare systems. It has been around in various forms since civilizations began to understand the relationship between economic growth and human wellbeing [1]. It serves as the basis for the preventive health guidelines that drive cancer and other disease screening recommendations in the U.S For many decades, clinical medicine has operated essentially independently from population health, except for screening guidelines, prompting the Institute of Medicine to warn of the dangers of separation in their 1997 report [2]
In this paper we describe the results of a study to systematically assess risk for 27 actionable conditions in primary care participants at four geographically and culturally diverse U.S healthcare systems
Summary
Risk assessment is a precision medicine technique that can be used to enhance population health when applied to prevention. Population health is an increasingly important concept in U.S healthcare systems. It has been around in various forms since civilizations began to understand the relationship between economic growth and human wellbeing [1]. It serves as the basis for the preventive health guidelines that drive cancer and other disease screening recommendations in the U.S For many decades, clinical medicine has operated essentially independently from population health, except for screening guidelines, prompting the Institute of Medicine to warn of the dangers of separation in their 1997 report [2]. Several prominent examples, such as breast cancer screening, have shown that the broad application of a single rule across an entire population is fraught with harms – both in over- and under- screening and the attendant medical, psychosocial and financial costs
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