title: Delivery of clinical genetic consultative services in the Veterans Health Administration.
abstract: OBJECTIVE
  To characterize the delivery of genetic consultative services for adults, we examined the prevalence and organizational determinants of genetic consult availability and the organization of these services in the Veterans Health Administration.
  
  
  METHODS
  We conducted a Web-based survey of Veterans Health Administration clinical leaders. We summarized facility characteristics using descriptive statistics. Multivariate logistic regression assessed associations between organizational characteristics and consult availability.
  
  
  RESULTS
  We received 353 survey responses from key informants representing 141 Veterans Affairs Medical Centers. Clinicians could obtain genetic consults at 110 (78%) Veterans Affairs Medical Centers. Cancer genetic and neurogenetic consults were most common. Academic affiliation (odds ratio = 3.0; 95% confidence interval: 1.1-8.6) and provider education about genetics (odds ratio = 2.9; 95% confidence interval: 1.1-7.8) were significantly associated with consult availability. The traditional model of multidisciplinary specialty clinics or coordinated services between geneticists and other providers was most prevalent, although variability in the organization of these services was described, with consults available on-site, at another Veterans Affairs Medical Center, via telegenetics, or at non-Veterans Health Administration facilities. The emerging model of nongeneticists integrating genetics into their practices was also reported, with considerable variability by specialty.
  
  
  CONCLUSIONS
  Both traditional and emerging models for genetic consultation are available in the Veterans Health Administration; however, there is variability in service organization that could influence quality of care.
authors: 1] Department of Research, VA HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy, VA Greater Los Angeles Healthcare System, Sepulveda, California, USA [2] Department of Medicine, Division of Medical Genetics, VA Greater Los Angeles Healthcare System, Los Angeles, California, USA [3] Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California, USA.
authors: Maren T
authors: MT
authors: Scheuner
authors: Department of Research, VA HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy, VA Greater Los Angeles Healthcare System, Sepulveda, California, USA.
authors: Nell
authors: N
authors: Marshall
authors: Department of Research, VA HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy, VA Greater Los Angeles Healthcare System, Sepulveda, California, USA.
authors: Andrew
authors: A
authors: Lanto
authors: 1] Department of Research, VA HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy, VA Greater Los Angeles Healthcare System, Sepulveda, California, USA [2] Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California, USA.
authors: Alison B
authors: AB
authors: Hamilton
authors: Department of Research, VA HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy, VA Greater Los Angeles Healthcare System, Sepulveda, California, USA.
authors: Sabine
authors: S
authors: Oishi
authors: Department of Research, VA Boston Healthcare System, Boston, Massachusetts, USA.
authors: Barbara
authors: B
authors: Lerner
authors: Department of Research, VA HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy, VA Greater Los Angeles Healthcare System, Sepulveda, California, USA.
authors: Martin
authors: M
authors: Lee
authors: 1] Department of Research, VA HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy, VA Greater Los Angeles Healthcare System, Sepulveda, California, USA [2] Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, California, USA.
authors: Elizabeth M
authors: EM
authors: Yano
mesh_terms: D003430:Cross-Sectional Studies; D005260:Female; D005826:Genetics, Medical / Q000706:statistics & numerical data*; D019538:Health Care Surveys / Q000379:methods*; D006297:Health Services Accessibility / Q000706:statistics & numerical data; D006787:Hospitals, Veterans; D006801:Humans; D008297:Male; D014481:United States; D014493:United States Department of Veterans Affairs / Q000706:statistics & numerical data*; D058014:Veterans Health; D064878:Web Browser