Factors influencing organizational adoption and implementation of clinical genetic services.
OBJECTIVE
We sought to identify characteristics of genetic services that facilitate or hinder adoption.


METHODS
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.


RESULTS
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.


CONCLUSIONS
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.
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.
Alison B
AB
Hamilton
VA HSR&D Center of Excellence for the Study of Healthcare Provider Behavior, VA Greater Los Angeles Healthcare System, Los Angeles, California, USA.
Sabine
S
Oishi
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 Health Policy and Management, Jonathan and Karin Fielding School of Public Health, University of California, Los Angeles, Los Angeles, California, USA.
Elizabeth M
EM
Yano
VA HSR&D Center of Excellence for the Study of Healthcare Provider Behavior, VA Greater Los Angeles Healthcare System, Los Angeles, California, USA.
Cynthia E
CE
Gammage
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 Health Policy and Management, Jonathan and Karin Fielding School of Public Health, University of California, Los Angeles, Los Angeles, California, USA.
Nell J
NJ
Marshall
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 Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California, USA.
Maren T
MT
Scheuner
D002309:Cardiology / Q000379:methods; D004059:Diffusion of Innovation; D033142:Genetic Services / Q000706:statistics & numerical data*; D005820:Genetic Testing / Q000706:statistics & numerical data*; D007722:Health Knowledge, Attitudes, Practice; D006306:Health Surveys / Q000379:methods / Q000706:statistics & numerical data; D006801:Humans; D007407:Interviews as Topic; D008495:Medical Oncology / Q000379:methods; D009462:Neurology / Q000379:methods; D010338:Pathology, Clinical / Q000379:methods; D010342:Patient Acceptance of Health Care; D011320:Primary Health Care / Q000379:methods; D014481:United States; D014493:United States Department of Veterans Affairs / Q000458:organization & administration*