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

The study took place in 35 clinics across six states in five U.S. health systems:

  • Duke University
  • Essentia Health
  • Medical College of Wisconsin
  • University of North Texas
  • Travis Air Force base

These settings represent a diversity of populations, including under-served, rural, migrant, and white collar populations; a diversity of clinics, including academic, indigent health, and community base;) and a diversity of data management, from paper-based medical records to four different electronic medical record systems.

The team developed implementation guides based upon their experiences in each of these settings to facilitate adoption by providers who want access to MeTree for clinic care.

Principal Investigators

Geoffrey Ginsburg, M.D., Ph.D.
Duke University School of Medicine
Director, Center for Applied Genomics and Precision Medicine
Professor of Medicine, Pathology, Nursing

Lori A. Orlando, M.D. MHS
Duke University School of Medicine
Associate Director, Center for Applied Genomics and Precision Medicine
Associate Professor of Medicine

Project Goals

  • To develop an optimal strategy for implementing MeTree into routine clinical practice in diverse settings.
  • To demonstrate the effectiveness of MeTree in increasing uptake of risk stratified evidence-based prevention guidelines.
  • To create a standardized family health history storage database that can integrate with electronic medical records for bi-directional communication of family and personal history data and risk assessment results.

Collaborating Sites

The 60th Medical Group, David Grant USAF Medical Center (DGMC)

The 60th Medical Group, David Grant USAF Medical Center (DGMC), is one of seven Air Force medical facilities with formal clinical investigation programs and resources specifically designated to support such operations. The primary mission of the Clinical Investigation Facility (CIF) is to provide expert research and training to support graduate medical education (GME) and clinical investigations. With oversight by Major Ruth Brenner of the Air Force Medical Support Agency Medical Research & Innovations, Troy Chinevere and his team, including Eduardo Sevilla and Patricia Beighle, led the implementation of this study at DGMC, within the primary care clinics of Flight Medicine, Internal Medicine, Family Health, and Family Medicine.

Essentia Health

Essentia Health is a not-for-profit, 501(c)(3) integrated healthcare delivery system headquartered in Duluth, Minnesota, with facilities in four states: Minnesota, Wisconsin, North Dakota and Idaho. Essentia Health integrates physician group practice, acute care delivery including primary, secondary and tertiary care centers, rural and critical access hospitals, innovative chronic disease management models and preventive services. Dr. Cathy McCarty and her team, including Drs. Joe Bianco and Pat Conway, led the implementation of this study at Essentia, and in particular within the primary care clinics in Ely and Hibbing to represent rural America.

The Medical College of Wisconsin

The Medical College of Wisconsin (MCW) is a private, national, freestanding institution that has been located on its current Milwaukee campus for 20 years. Founded originally as Marquette University School of Medicine, a medical school with a strong educational focus, its stature as a research institution has grown immensely during the past two decades. Annually, Medical College faculty direct or collaborate on more than 3,000 research studies and more than 1,300 scientific papers by Medical College faculty are published in peer-reviewed medical journals. The College is the largest research institution in the Milwaukee metro area and the second-largest in Wisconsin. Dr. David Dimmock and his team including Alison LaPean Kirschner and Jennifer Geurts led the implementation of this study at MCW, and in particular within the primary care clinics of Froedterts and the MCW clinics –beginning initially with the Plank Road and The Westbrook Primary Care Clinics.

The University of North Texas Health Science Center

The University of North Texas Health Science Center is exclusively a graduate-level university focusing on the life sciences and has made tremendous progress in meeting the state’s needs for physicians, physician extenders, public health workers and scientists for industry and academia. Opened in 1970 as the Texas College of Osteopathic Medicine, the 1,500-student campus has grown to also comprise the Graduate School of Biomedical Sciences, School of Public Health, College of Pharmacy, and School of Health Professions. Their mission is to create solutions for a healthier community for the people of Texas and beyond through excellence in education, research, clinical care and community engagement. Dr. Deanna Cross and Dr. Kimberly Fulda and their team, including Dr. Anna Espinoza, Janhavi Mallaiah and Michelle Lee, led the implementation of this study at the UNTHSC Central Family Medicine and Seminary Family Medicine clinics that serve underrepresented populations.

Key Personnel

  • Geoffrey S Ginsburg, M.D., Ph.D. – PI, Duke
  • Lori Orlando, M.D. – Co-PI, Duke
  • Teji Rakhra-Burris, M.A. – Project Leader, Duke
  • R. Ryanne Wu, M.D. – Implementation co-lead, Duke
  • Rachel Myers, Ph.D. – Biostatistician, Duke
  • Michael Musty – Project Manager, Duke
  • Cathy McCarty, M.D. – Co-I, Essentia
  • David Dimmock, M.D. – Co-I, MCW
  • Kimberly Fulda, DrPH – Co-I, UNT
  • Troy Chinevere, Ph.D., Lt. Col. – Co-I, USAF, Travis

More details are available at Duke Center for Applied Genomics and Precision Medicine