A Cluster Randomized Trial of a Personalized Multi-Condition Risk Assessment in Primary Care

Published:September 16, 2016DOI:


      Personal risk for multiple conditions should be assessed in primary care. This study evaluated whether collection of risk factors to generate electronic health record (EHR)-linked health risk appraisal (HRA) for coronary heart disease, diabetes, breast cancer, and colorectal cancer was associated with improved patient–provider communication, risk assessment, and plans for breast cancer screening.


      This pragmatic trial recruited adults with upcoming visits to 11 primary care practices during 2013–2014 (N=3,703). Pre-visit, intervention patients completed a risk factor and perception assessment and received an HRA; coded risk factor data were sent to the EHR. Post-visit, intervention patients reported risk perception. Pre-visit, control patients only completed the risk perception assessment; post-visit they also completed the risk factor assessment and received the HRA. No data were sent to the EHR for controls. Accuracy/improvement of self-perceived risk was assessed by comparing self-perceived to calculated risk.


      The intervention was associated with improvement of patient–provider communication of changes to improve health (78.5% vs 74.1%, AOR=1.67, 99% CI=1.07, 2.60). There was a similar trend for discussion of risk (54.1% vs 45.5%, AOR=1.34, 95% CI=0.97, 1.85). The intervention was associated with greater improvement in accuracy of self-perceived risk for diabetes (16.0% vs 12.6%, p=0.006) and colorectal cancer (27.9% vs 17.2%, p<0.001) with a similar trend for coronary heart disease and breast cancer. There were no changes in plans for breast cancer screening.


      Patient-reported risk factors and EHR-linked multi-condition HRAs in primary care can modestly improve communication and promote accuracy of self-perceived risk.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to American Journal of Preventive Medicine
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Yach D.
        • Hawkes C.
        • Gould C.L.
        • Hofman K.J.
        The global burden of chronic diseases: overcoming impediments to prevention and control.
        JAMA. 2004; 291: 2616-2622
        • Yoon P.W.
        • Scheuner M.T.
        • Peterson-Oehlke K.L.
        • Gwinn M.
        • Faucett A.
        • Khoury M.J.
        Can family history be used as a tool for public health and preventive medicine?.
        Genet Med. 2002; 4: 304-310
        • Wang C.
        • O’Neill S.M.
        • Rothrock N.
        • et al.
        Comparison of risk perceptions and beliefs across common chronic diseases.
        Prev Med. 2009; 48: 197-202
        • Sabatino S.A.
        • McCarthy E.P.
        • Phillips R.S.
        • Burns R.B.
        Breast cancer risk assessment and management in primary care: provider attitudes, practices, and barriers.
        Cancer Detect Prev. 2007; 31: 375-383
        • Acheson L.S.
        • Wiesner G.L.
        • Zyzanski S.J.
        • Goodwin M.A.
        • Stange K.C.
        Family history-taking in community family practice: implications for genetic screening.
        Genet Med. 2000; 2: 180-185
        • Baghelai C.
        • Nelkin V.S.
        • Miller T.R.
        Health Risk Appraisals in Primary Care: Current Knowledge and Potential Applications to Improve Preventive Services and Chronic Care.
        Agency for Healthcare Research & Quality, Rockville, MD2009
        • Kreuter M.W.
        • Strecher V.J.
        Changing inaccurate perceptions of health risk: results from a randomized trial.
        Health Psychol. 1995; 14: 56-63
        • Onega T.
        • Beaber E.F.
        • Sprague B.L.
        • et al.
        Breast cancer screening in an era of personalized regimens: a conceptual model and National Cancer Institute initiative for risk-based and preference-based approaches at a population level.
        Cancer. 2014; 120: 2955-2964
        • Colditz G.A.
        • Atwood K.A.
        • Emmons K.
        • et al.
        Harvard report on cancer prevention volume 4: Harvard Cancer Risk Index.
        Cancer Causes Control. 2000; 11: 477-488
        • Kim D.J.
        • Rockhill B.
        • Colditz G.A.
        Validation of the Harvard Cancer Risk Index: a prediction tool for individual cancer risk.
        J Clin Epidemiol. 2004; 57: 332-340
        • Wagner E.H.
        • Beery W.L.
        • Schoenbach V.J.
        • Graham R.M.
        An assessment of health hazard/health risk appraisal.
        Am J Public Health. 1982; 72: 347-352
        • Nagykaldi Z.J.
        • Voncken-Brewster V.
        • Aspy C.B.
        • Mold J.W.
        Novel computerized health risk appraisal may improve longitudinal health and wellness in primary care: a pilot study.
        Appl Clin Inform. 2013; 4: 75-87
        • Kaplan C.P.
        • Livaudais-Toman J.
        • Tice J.A.
        • et al.
        A randomized, controlled trial to increase discussion of breast cancer in primary care.
        Cancer Epidemiol Biomarkers Prev. 2014; 23: 1245-1253
        • Wang C.
        • Sen A.
        • Ruffin M.T.
        • et al.
        Family history assessment: impact on disease risk perceptions.
        Am J Prev Med. 2012; 43: 392-398
        • Orlando L.A.
        • Wu R.R.
        • Beadles C.
        • et al.
        Implementing family health history risk stratification in primary care: impact of guideline criteria on populations and resource demand.
        Am J Med Genet C Semin Med Genet. 2014; 166: 24-33
        • Ruffin M.T.
        • Nease Jr., D.E.
        • Sen A.
        • et al.
        Effect of preventive messages tailored to family history on health behaviors: the Family Healthware Impact Trial.
        Ann Fam Med. 2011; 9: 3-11
        • Haas J.S.
        • Linder J.A.
        • Park E.R.
        • et al.
        Proactive tobacco cessation outreach to smokers of low socioeconomic status: a randomized clinical trial.
        JAMA Intern Med. 2015; 175: 218-226
        • Chen E.H.
        • Bodenheimer T.
        Improving population health through team-based panel management: comment on “Electronic medical record reminders and panel management to improve primary care of elderly patients.”.
        Arch Intern Med. 2011; 171: 1558-1559