Assessing multilevel determinants of adoption and implementation of genomic medicine: an organizational mixed-methods approach

Abstract

Purpose: Adoption and implementation of evidence-based genetic and genomic medicine have been slow. We describe a methodology for identifying the influence of organizational factors on adoption and implementation of these services in health-care organizations. Methods:We illustrate a three-component, mixed-methods health services research approach, including expert panels, qualitative interviews with key informants, and quantitative surveys completed by key informants.Results: This research approach yielded a baseline assessment of existing genetic health-care models in the Veterans Health Administration and identified organizational barriers to and facilitators of adoption. In aggregate, the panel and key informant strategies created a communication network of relevant organizational stakeholders and a detailed foundation of organizational knowledge from which to design tools and models for implementation-level genetic/genomic translation. Conclusion:Expert panel and key informant strategies can be used to create a backdrop of stakeholder involvement and baseline organizational knowledge within which to plan translation research and to inform strategic planning and policies for adoption and implementation of genetic services in health-care organizations.

Organizational readiness to implement population‐based screening and genetic service delivery for hereditary cancer prevention and control

“…Similarly, hurdles to implementing population‐based HBOC screening and follow‐up acknowledged in the literature include information technology limitations, lack of leadership support, workflow impact, and liability concerns (Anderson & Hoskins, ; Owens, Gallagher, Kincheloe, & Ruetten, ). While our results are consistent with many of these findings and prior work on genomic implementation (Hamilton et al, ; Oishi et al, ), they indicate that some implementation barriers may be decreasing over time and present to different degrees within different settings. Ethical concerns about predictive genetic testing and costs to both patients and delivery systems, for example, appear to be less salient given national practice guidelines, falling genetic testing costs, and improved reimbursement.…”

Distribution of Genomic Testing Resources by Oncology Practice and Rurality: A Nationally Representative Study

“…1 Often referred to as precision oncology, these genomic tests include single-gene and multigene tumor panels that require access to advanced pathology, laboratory, personnel, and organizational resources. 2,3 For example, precision oncology approaches can use NGS on molecularly heterogeneous tumor specimens to inform the use of molecularly targeted therapy, assist in identifying patients who may benefit from less invasive treatments, and reduce overtreatment of others. 4,5 However, despite the promising utility of precision oncology, the integration of genomic testing into health care settings is challenging.…”

Comparing behavioral health models for reducing risky drinking among older male veterans

“…Prior VA research suggests that organizational factors can present both barriers and facilitators to quality care, diffusion of evidence-based treatments, treatment effectiveness, and patient outcomes (48). In this study, four out of five VAMCs offered geriatric specialty services which included geriatric primary care, extended care, geriatric evaluation and management (GEM) teams, home-based primary care, and/or care coordination—all of which may influence health services utilization and patient outcomes among older male veterans.…”