Hamilton Alison B, Oishi Sabine, Yano Elizabeth M, Gammage Cynthia E, Marshall Nell J, Scheuner Maren T
1] VA HSR&D Center of Excellence for the Study of Healthcare Provider Behavior, VA Greater Los Angeles Healthcare System, Los Angeles, California, USA [2] Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California, USA.
VA HSR&D Center of Excellence for the Study of Healthcare Provider Behavior, VA Greater Los Angeles Healthcare System, Los Angeles, California, USA.
Genet Med. 2014 Mar;16(3):238-45. doi: 10.1038/gim.2013.101. Epub 2013 Aug 15.
We sought to identify characteristics of genetic services that facilitate or hinder adoption.
We conducted semi-structured key informant interviews in five clinical specialties (primary care, medical oncology, neurology, cardiology, pathology/laboratory medicine) within 13 Veterans Administration facilities.
Genetic services (defined as genetic testing and consultation) were not typically characterized by informants (n = 64) as advantageous for their facilities or their patients; compatible with organizational norms of low cost and high clinical impact; or applicable to patient populations or norms of clinical care. Furthermore, genetic services had not been systematically adopted in most facilities because of their complexity: knowledge of and expertise on genetic testing was limited, and organizational barriers to utilization of genetic services were formidable. The few facilities that had some success with implementation of genetic services had knowledgeable clinicians interested in developing services and organizational-level facilitators such as accessible genetic test-ordering processes.
Adoption and implementation of genetic services will require a multilevel effort that includes education of providers and administrators, opportunities for observing the benefits of genetic medicine, strategies for reducing the complexity of genomic medicine, expanded strategies for accessing genetics expertise and streamlining utilization, and resources dedicated to assessing the value of genetic information for the outcomes that matter to health-care organizations.
我们试图确定促进或阻碍基因服务采用的特征。
我们在13个退伍军人管理局设施内的五个临床专科（初级保健、医学肿瘤学、神经病学、心脏病学、病理学/检验医学）进行了半结构化关键信息人访谈。
信息提供者（n = 64）通常并不认为基因服务（定义为基因检测和咨询）对其所在机构或患者具有优势；不符合低成本和高临床影响的组织规范；或不适用于患者群体或临床护理规范。此外，由于基因服务的复杂性，大多数机构尚未系统地采用基因服务：对基因检测的知识和专业技能有限，并且利用基因服务存在巨大的组织障碍。少数在基因服务实施方面取得一定成功的机构拥有对开展服务感兴趣的知识渊博的临床医生以及组织层面的促进因素，如便捷的基因检测订购流程。
基因服务的采用和实施需要多层次的努力，包括对提供者和管理人员的教育、观察基因医学益处的机会、降低基因组医学复杂性的策略、扩大获取基因专业知识和简化利用的策略，以及用于评估基因信息对医疗保健组织重要结果的价值的资源。
