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


CONCLUSIONS
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.
Veterans Affairs Health Services Research and Development Center for the Study of Healthcare Innovation, Implementation and Policy, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California, USA.
Sabine M
SM
Oishi
Veterans Affairs Health Services Research and Development Center for the Study of Healthcare Innovation, Implementation and Policy, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California, USA.
Nell
N
Marshall
Veterans Affairs Health Services Research and Development Center for the Study of Healthcare Innovation, Implementation and Policy, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California, USA.|Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California, USA.
Alison B
AB
Hamilton
Veterans Affairs Health Services Research and Development Center for the Study of Healthcare Innovation, Implementation and Policy, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California, USA.|Department of Health Policy and Management, University of California, Los Angeles, Fielding School of Public Health, Los Angeles, California, USA.
Elizabeth M
EM
Yano
Veterans Affairs Health Services Research and Development Center for Healthcare Organization and Implementation Research, Veterans Affairs Boston Healthcare System, Boston, Massachusetts, USA.
Barbara
B
Lerner
Veterans Affairs Health Services Research and Development Center for the Study of Healthcare Innovation, Implementation and Policy, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California, USA.|Division of Medical Genetics, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California, USA.|Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California, USA.
Maren T
MT
Scheuner
D003695:Delivery of Health Care / Q000379:methods / Q000458:organization & administration; D019317:Evidence-Based Medicine; D005826:Genetics, Medical / Q000379:methods / Q000458:organization & administration; D023281:Genomics / Q000379:methods / Q000458:organization & administration; D006801:Humans; D008962:Models, Theoretical; D010865:Pilot Projects; D057170:Translational Research, Biomedical; D014481:United States; D014493:United States Department of Veterans Affairs