Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia, PA, USA.
Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA.
Genet Med. 2019 Jul;21(7):1534-1540. doi: 10.1038/s41436-018-0378-9. Epub 2018 Nov 23.
Research on genomic medicine integration has focused on applications at the individual level, with less attention paid to implementation within clinical settings. Therefore, we conducted a qualitative study using the Consolidated Framework for Implementation Research (CFIR) to identify system-level factors that played a role in implementation of genomic medicine within Implementing GeNomics In PracTicE (IGNITE) Network projects.
Up to four study personnel, including principal investigators and study coordinators from each of six IGNITE projects, were interviewed using a semistructured interview guide that asked interviewees to describe study site(s), progress at each site, and factors facilitating or impeding project implementation. Interviews were coded following CFIR inner-setting constructs.
Key barriers included (1) limitations in integrating genomic data and clinical decision support tools into electronic health records, (2) physician reluctance toward genomic research participation and clinical implementation due to a limited evidence base, (3) inadequate reimbursement for genomic medicine, (4) communication among and between investigators and clinicians, and (5) lack of clinical and leadership engagement.
Implementation of genomic medicine is hindered by several system-level barriers to both research and practice. Addressing these barriers may serve as important facilitators for studying and implementing genomics in practice.
基因组医学整合的研究主要集中在个体层面的应用上，而对临床环境中实施的关注较少。因此，我们使用实施研究整合框架（CFIR）进行了一项定性研究，以确定在实施基因组医学方面发挥作用的系统层面因素在实施基因组医学在实践中的网络（IGNITE）项目中。
多达四名研究人员，包括每个 IGNITE 项目的主要研究人员和研究协调员，使用半结构化访谈指南进行了访谈，该指南要求受访者描述研究地点、每个地点的进展情况以及促进或阻碍项目实施的因素。访谈按照 CFIR 内部环境结构进行编码。
主要障碍包括：（1）将基因组数据和临床决策支持工具整合到电子健康记录中的局限性，（2）由于证据基础有限，医生对基因组研究参与和临床实施的不情愿，（3）对基因组医学的报销不足，（4）调查人员和临床医生之间以及之间的沟通，以及（5）缺乏临床和领导参与。
基因组医学的实施受到研究和实践中几个系统层面障碍的阻碍。解决这些障碍可能是研究和实施实践中基因组学的重要促进因素。
