{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,30]],"date-time":"2026-10-30T16:38:15Z","timestamp":1793378295969,"version":"4.5.0"},"reference-count":36,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2014,3,10]],"date-time":"2014-03-10T00:00:00Z","timestamp":1394409600000},"content-version":"vor","delay-in-days":9,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["American J of Med Genetics Pt C"],"published-print":{"date-parts":[[2014,3]]},"abstract":"<jats:sec>\n                    <jats:label\/>\n                    <jats:p>\n                      The Genomic Medicine Model aims to facilitate patient engagement, patient\/provider education of genomics\/personalized medicine, and uptake of risk\u2010stratified evidence\u2010based prevention guidelines using MeTree, a patient\u2010facing family health history (FHH) collection and clinical decision support (CDS) program. Here we report the number of increased risk (above population\u2010level risk) patients identified for breast\/ovarian cancer, colon cancer, hereditary syndrome risk, and thrombosis; the prevalence of FHH elements triggering increased\u2010risk status; and the resources needed to manage their risk.\n                      <jats:italic>Study design<\/jats:italic>\n                      : hybrid implementation\u2010effectiveness study of adults with upcoming well\u2010visits in 2 primary care practices in Greensboro, NC.\n                      <jats:italic>Participants<\/jats:italic>\n                      : 1,184, mean age\u2009=\u200958.8, female\u2009=\u200958% (N\u2009=\u2009694), non\u2010white\u2009=\u200920% (N\u2009=\u2009215).\n                      <jats:italic>Increased Risk<\/jats:italic>\n                      : 44% (N\u2009=\u2009523).\n                      <jats:italic>Recommendations<\/jats:italic>\n                      : genetic counseling\u2009=\u200926% (N\u2009=\u2009308), breast MRI\u2009=\u20090.8% (N\u2009=\u200910), breast chemoprophylaxis\u2009=\u20095% (N\u2009=\u200958), early\/frequent colonoscopies\u2009=\u200919% (N\u2009=\u2009221), ovarian cancer screening referral\u2009=\u20091% (N\u2009=\u200914), thrombosis testing\/counseling\u2009=\u20092.4% (N\u2009=\u200971).\n                      <jats:italic>FHH elements<\/jats:italic>\n                      : 8 FHH elements lead to 37.3% of the increased risk categorizations (by frequency): first\u2010degree\u2010relative (FDR) with polyps age \u226560 (7.1%, N\u2009=\u200985), three relatives with Lynch\u2010related cancers (5.4%, N\u2009=\u200965), FDR with polyps age &lt;60 (5.1%, N\u2009=\u200961), three relatives on same side of family with same cancer (4.9%, N\u2009=\u200959), Gail score \u22651.66% (4.9%, N\u2009=\u200958), two relatives with breast cancer (one \u2264age 50) (4.1%, N\u2009=\u200949), one relative with breast cancer \u2264age 40 (4.1%, N\u2009=\u200948), FDR with colon cancer age \u226560 (1.7%, N\u2009=\u200920). MeTree identifies a high percentage of individuals in the general primary care population needing non\u2010routine risk management\/prevention for the selected conditions. Implementing risk\u2010stratification in primary care will likely increase demand for related\u2010resources, particularly colon screening and GC. Understanding the prevalence of FHH elements helps predict resource needs and may aid in guideline development. \u00a9 2014 Wiley Periodicals, Inc.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/ajmg.c.31388","type":"journal-article","created":{"date-parts":[[2014,3,10]],"date-time":"2014-03-10T13:43:59Z","timestamp":1394459039000},"page":"24-33","source":"Crossref","is-referenced-by-count":36,"title":["Implementing family health history risk stratification in primary care: Impact of guideline criteria on populations and resource demand"],"prefix":"10.1002","volume":"166","author":[{"given":"Lori A.","family":"Orlando","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"R. Ryanne","family":"Wu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chris","family":"Beadles","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tiffany","family":"Himmel","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adam H.","family":"Buchanan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karen P.","family":"Powell","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elizabeth R.","family":"Hauser","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vincent C.","family":"Henrich","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Geoffrey S.","family":"Ginsburg","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2014,3,10]]},"reference":[{"key":"e_1_2_6_2_1","doi-asserted-by":"publisher","DOI":"10.1097\/00125817-200005000-00004"},{"key":"e_1_2_6_3_1","doi-asserted-by":"publisher","DOI":"10.1109\/TAC.1974.1100705"},{"key":"e_1_2_6_4_1","doi-asserted-by":"publisher","DOI":"10.7326\/0000605-200912150-00165"},{"key":"e_1_2_6_5_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10897-007-9090-7"},{"key":"e_1_2_6_6_1","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2002.05.121"},{"key":"e_1_2_6_7_1","doi-asserted-by":"publisher","DOI":"10.1378\/chest.126.3_suppl.401S"},{"key":"e_1_2_6_8_1","doi-asserted-by":"publisher","DOI":"10.1159\/000294415"},{"key":"e_1_2_6_9_1","doi-asserted-by":"publisher","DOI":"10.1097\/MLR.0b013e3182408812"},{"key":"e_1_2_6_10_1","doi-asserted-by":"publisher","DOI":"10.1093\/jnci\/90.18.1371"},{"key":"e_1_2_6_11_1","doi-asserted-by":"publisher","DOI":"10.1093\/jnci\/81.24.1879"},{"key":"e_1_2_6_12_1","doi-asserted-by":"publisher","DOI":"10.1038\/nature11632"},{"key":"e_1_2_6_13_1","doi-asserted-by":"publisher","DOI":"10.1370\/afm.60"},{"key":"e_1_2_6_14_1","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0b013e3182699a2b"},{"key":"e_1_2_6_15_1","doi-asserted-by":"publisher","DOI":"10.1136\/jmg.2003.010918"},{"key":"e_1_2_6_16_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.mrrev.2008.01.002"},{"key":"e_1_2_6_17_1","doi-asserted-by":"publisher","DOI":"10.3322\/canjclin.56.4.213"},{"key":"e_1_2_6_18_1","doi-asserted-by":"publisher","DOI":"10.3322\/CA.2007.0018"},{"key":"e_1_2_6_19_1","unstructured":"National Comprehensive Cancer Network.2011.Family history risk markers for hereditary cancer syndrome."},{"key":"e_1_2_6_20_1","doi-asserted-by":"publisher","DOI":"10.1002\/ijc.28300"},{"key":"e_1_2_6_21_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.amepre.2009.03.002"},{"key":"e_1_2_6_22_1","doi-asserted-by":"publisher","DOI":"10.1186\/1472-6963-11-264"},{"key":"e_1_2_6_23_1","first-page":"287","article-title":"Development and validation of a Primary Care\u2010based family health history and decision support program (MeTree\u00a9)","volume":"74","author":"Orlando LA","year":"2013","journal-title":"N C Med J"},{"key":"e_1_2_6_24_1","doi-asserted-by":"publisher","DOI":"10.2217\/pme.13.20"},{"key":"e_1_2_6_25_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1524-4741.2009.00690.x"},{"key":"e_1_2_6_26_1","volume-title":"R: A Language and Environment for Statistical Computing","author":"R Core Team","year":"2013"},{"key":"e_1_2_6_27_1","first-page":"229","article-title":"Linkage strategies for genetically complex traits. 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