National Meeting 2009

3092 — Priorities for Delivering and Studying Health Services Genomics: Results from an Expert Panel

Scheuner MT (VA Greater Los Angeles, Center for the Study of Healthcare Provider Behavior) , Oishi SM (Center for the Study of Healthcare Provider Behavior), Simon B (Center for the Study of Healthcare Provider Behavior), Rubenstein LV (Center for the Study of Healthcare Provider Behavior), Yano EM (Center for the Study of Healthcare Provider Behavior)

Objectives:
Integrating genetic information into clinical practice may lead to better health outcomes through risk-appropriate screening, earlier and more accurate diagnosis, and targeted therapies. The VA has demonstrated significant leadership in considering adoption of genomic medicine. As an emerging field of clinical care and research, we convened an expert panel to set priorities for the delivery and evaluation of genomic medicine.

Methods:
Using a modified Delphi panel process, we assembled nationally known medical geneticists (5 MGs) and primary care/health services researchers (8 PC/HSRs) to set clinical care and research priorities. Panelists received background materials and a structured, 75-item survey that dealt with delivery of genetic services and health services genomics research issues that should be considered in the next five years. Panelists rated the importance of different types of genetic conditions, clinical delivery models and features, and strategies using a 9-point ordinal scale, with results presented as mean scores.

Results:
We obtained and fed back survey results from 10 panelists (5 MG and 5 PC/HSR) to all panel members. Acquired genetic conditions (e.g., cancer) and common single gene disorders (e.g., hereditary colon cancer syndromes) were the conditions rated as having the greatest clinical importance and potential demand in the next five years. Physician geneticists were uniformly rated as best-suited to diagnose and manage genetic conditions, while genetic counselors were considered best-suited for risk assessment and patient education. However, experts agreed that access to these professionals is limited. Key factors for adoption of genomic medicine at the VA included availability of: prevention/management options for genetic conditions, clinical guidelines, genetic tests, physician geneticists at the VA, a centralized genetics program at the VA, clinical decision support in CPRS, and genetics education. Highest research priorities (mean scores > 8) focused on clinical guidelines and tools in CPRS for familial risk assessment and genetic testing.

Implications:
Adopting genomic medicine within the VA holds great promise for personalizing veterans’ care, but VA providers lack access to needed clinical expertise, genetic services, and strategies for integrating genomic medicine into practice.

Impacts:
Future research on how genetic services are currently arranged in the context of local needs should be pursued.