Maren T Scheuner1, Alison B Hamilton2, Jane Peredo3, Taylor J Sale3, Colletta Austin3, Stuart C Gilman4, M Scott Bowen5, Caroline Lubick Goldzweig1, Martin Lee6, Brian S Mittman3, Elizabeth M Yano6. 1. 1] VA Greater Los Angeles Healthcare System, Los Angeles, California, USA [2] Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California, USA. 2. 1] VA Greater Los Angeles Healthcare System, Los Angeles, California, USA [2] Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, California, USA. 3. VA Greater Los Angeles Healthcare System, Los Angeles, California, USA. 4. Office of Academic Affiliations, Veterans Health Administration, Washington DC, USA. 5. Office of Public Health Genomics, Centers for Disease Control and Prevention, Atlanta, Georgia, USA. 6. 1] VA Greater Los Angeles Healthcare System, Los Angeles, California, USA [2] UCLA Fielding School of Public Health, Los Angeles, California, USA.
Abstract
PURPOSE: We developed, implemented, and evaluated a multicomponent cancer genetics toolkit designed to improve recognition and appropriate referral of individuals at risk for hereditary cancer syndromes. METHODS: We evaluated toolkit implementation in the women's clinics at a large Veterans Administration medical center using mixed methods, including pre-post semistructured interviews, clinician surveys, and chart reviews, and during implementation, monthly tracking of genetic consultation requests and use of a reminder in the electronic health record. We randomly sampled 10% of progress notes 6 months before (n = 139) and 18 months during implementation (n = 677). RESULTS: The toolkit increased cancer family history documentation by almost 10% (26.6% pre- and 36.3% postimplementation). The reminder was a key component of the toolkit; when used, it was associated with a twofold increase in cancer family history documentation (odds ratio = 2.09; 95% confidence interval: 1.39-3.15), and the history was more complete. Patients whose clinicians completed the reminder were twice as likely to be referred for genetic consultation (4.1-9.6%, P < 0.0001). CONCLUSION: A multicomponent approach to the systematic collection and use of family history by primary-care clinicians increased access to genetic services.
PURPOSE: We developed, implemented, and evaluated a multicomponent cancer genetics toolkit designed to improve recognition and appropriate referral of individuals at risk for hereditary cancer syndromes. METHODS: We evaluated toolkit implementation in the women's clinics at a large Veterans Administration medical center using mixed methods, including pre-post semistructured interviews, clinician surveys, and chart reviews, and during implementation, monthly tracking of genetic consultation requests and use of a reminder in the electronic health record. We randomly sampled 10% of progress notes 6 months before (n = 139) and 18 months during implementation (n = 677). RESULTS: The toolkit increased cancer family history documentation by almost 10% (26.6% pre- and 36.3% postimplementation). The reminder was a key component of the toolkit; when used, it was associated with a twofold increase in cancer family history documentation (odds ratio = 2.09; 95% confidence interval: 1.39-3.15), and the history was more complete. Patients whose clinicians completed the reminder were twice as likely to be referred for genetic consultation (4.1-9.6%, P < 0.0001). CONCLUSION: A multicomponent approach to the systematic collection and use of family history by primary-care clinicians increased access to genetic services.
Authors: Catharine Wang; Ananda Sen; Melissa Plegue; Mack T Ruffin; Suzanne M O'Neill; Wendy S Rubinstein; Louise S Acheson Journal: Prev Med Date: 2015-04-19 Impact factor: 4.018
Authors: Lauren Puryear; Natalie Downs; Andrea Nevedal; Eleanor T Lewis; Kelly E Ormond; Maria Bregendahl; Carlos J Suarez; Sean P David; Steven Charlap; Isabella Chu; Steven M Asch; Neda Pakdaman; Sang-Ick Chang; Mark R Cullen; Latha Palaniappan Journal: J Community Genet Date: 2017-12-27
Authors: Jada G Hamilton; Ekland Abdiwahab; Heather M Edwards; Min-Lin Fang; Andrew Jdayani; Erica S Breslau Journal: J Gen Intern Med Date: 2016-12-19 Impact factor: 5.128
Authors: Maren T Scheuner; Kenute Myrie; Jane Peredo; Lori Hoffman-Hogg; Margaret Lundquist; Stephanie L Guerra; Douglas Ball Journal: Fed Pract Date: 2020-08
Authors: Jason L Vassy; Charles A Brunette; Nilla Majahalme; Sanjay Advani; Lauren MacMullen; Cynthia Hau; Andrew J Zimolzak; Stephen J Miller Journal: Contemp Clin Trials Date: 2018-10-24 Impact factor: 2.226