Tablet PC-based tool for personalized risk assessment
To address family history collection, interpretation, and application in busy primary care practices, NCHPEG has collaborated collaborating with the March of Dimes, Genetic Alliance, Harvard Partners, and the Health Resources and Services Administration to develop and evaluate of a novel family history tool that focuses on prenatal and neonatal health. The tool helps to improve health outcomes for the female patient, fetus, and family by providing clinical decision support and educational resources for risk assessment based on family history.
The Pregnancy & Health Profile: A Risk Assessment & Genetic Screening Tool
This family history tool, the Pregnancy & Health Profile, is an adaptation of the Harvard Partners’ Hughes riskApps™, a cancer risk-assessment software. The Pregnancy & Health Profile is a tablet PC-based tool that collects family health history plus pregnancy risk factor information and generates, through clinical decision support, personalized risk assessment messages and point-of-care educational material for prenatal providers. Download a one-page fact sheet about the project>>
Components of the Pregnancy & Health Profile include:
- Pregnancy and Family History Questionnaire: A patient-friendly computerized intake form collects personal and family health history for both the patient and the father of the baby, patient and father of the baby demographics, past pregnancy history, and lifestyle and behavioral factors that impact prenatal health. The Pregnancy and Family History Questionnaire contains educational patient videos, information buttons to help with medical terminology, and educational messages that help the patient navigate the questionnaire and orient her to the first prenatal appointment. Prior to the first appointment using the computerized intake form, offices may send or print for their patients a web article describing what to expect during the first prenatal appointment.
- Prenatal and Women's Health Risk Assessment Algorithms: The project partners developed the risk assessment algorithms based on evidence-based information in the literature, professional society recommendations and guidelines, and expert consensus. These algorithsm support the clincial decision-support that provides point-of-care guidances to the clinician.
OB/GYN Clinic Module: A portal for the clinican allows the clinician to view patient-entered information and the resulting risk assessment report and clinical decision-support. Clinicans can use the OB-GYN Clinic Module to review, modify, and document new patient risk factors.
- Pregnancy Health Profile Report: After the patient enters her information into the tool, the Pregnancy Health Profile report is automatically and immediately generated. This report is prepopulated with the patient-entered information. Clinical decision-support is presented in a table that provides the clinician with the red flag or risk factor(s) that put the patient at increased risk, the syndrome or condition for which evaluation is suggested, and the suggested action. The report includes a three-generation pedigree.
- Provider Education Sheets: As part of the clinical decision-support for each condition, clinicians can access point-of-care educational materials. This information provides a brief background about the condition in question, genetic and other risk factors, management suggestions, and summarizes the evidence or professional society guidelines that support risk assessment for the condition. It includes web links for additional disease-specific information.
- Patient Education Sheets: If a patient is flagged as at increased risk for a condition, a patient fact sheet is automatically generated, for the condition. In this way, the patient can receive personalized educational materials to facilitate communication with the clinician and shared decision-making. Fact sheets for many conditions are based on March of Dimes health education materials related to birth defects and other pregnancy health topics.
The Pregnancy & Health Profile collects personal and family history information, and performs risk assessment, for the following conditions or categories:
Single-gene, or Mendelian, conditions
Clinical Implementation & Evaluation
Four clinical practices are currently testing the tool in their prenatal workflow:
- Clearvista practice, Community Health Network, Indianapolis, Indiana
- Maine-Dartmouth Family Medicine Residency, Augusta and Fairfield, Maine
- Montefiore Medical Center Comprehensive Family Care Center, Bronx, New York
- Mountain Area Health Education Center, Asheville, North Carolina
These practices are integrating the Pregnancy & Health Profile into the first prenatal visit for all eligible patients presenting for prenatal care, and partnering with NCHPEG, March of Dimes, Genetic Alliance, Harvard Partners, and HRSA in its evaluation. For more information about our clinical partners, see the recent press release announcing the program>>
An example clinic flow is below.
Clinician Continuing Education
As part of this project, the partners have developed a grand rounds presentation, "The Value of Family Health Histroy in the Prenatal Care Practice."
This 60-minute presentation is targeted to the primary care prenatal provider, including obstetricians, nurse midwives, nurse practitioners, family medicine providers, physician assistants, and other prenatal care providers. It is appropriate for clinical trainees, medical residents, and practicing providers. This powerpoint slide set with presentation notes provides information on collecting and interpreting family health history and applies these concepts through three interactive case studies.
Questions? Want to get involved? Contact Emily Edelman.