title: The value of genetic testing: beyond clinical utility.
abstract: To assess the value of genetic testing from the perspective of the Department of Veterans Affairs (VA) clinical leadership.
  
  
  
  We administered an Internet-based survey to VA clinical leaders nationwide. Respondents rated the value (on a 5-point scale) of each of six possible reasons for genetic testing. Bivariate and linear regressions identified associations between value ratings and environmental, organizational, provider, patient, and encounter characteristics.
  
  
  
  Respondents (n = 353; 63% response rate) represented 92% of VA medical centers. Tests that inform clinical management had the highest value rating (58.6%), followed by tests that inform disease prevention (56.4%), reproductive options (50.1%), life planning (43.9%), and a suspected (39.9%) or established (32.3%) diagnosis. Factors positively associated with high value included a culture that fosters adoption of genomics, specialist versus primary care provider, genetic tests available on laboratory menus, availability of genetic testing guidelines, clinicians knowing when to request genetics referrals, and availability of genetics professionals.
  
  
  
  Our results demonstrate the varied value of genetic testing from the perspective of clinical leadership within a health-care system. Engaging organizational leadership in understanding the various reasons for genetic testing and its value beyond clinical utility may increase adoption of genetic tests to support patient-centered care.Genet Med advance online publication 15 December 2016.
authors.affiliation: VA HSR&D Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Boston, Massachusetts, USA.
authors.forename: Barbara
authors.initials: B
authors.lastname: Lerner
authors.affiliation: VA HSR&D Center for the Study of Healthcare Innovation, Implementation &amp;Policy, VA Greater Los Angeles Healthcare System, Los Angeles, California, USA.
authors.forename: Nell
authors.initials: N
authors.lastname: Marshall
authors.affiliation: VA HSR&D Center for the Study of Healthcare Innovation, Implementation &amp;Policy, VA Greater Los Angeles Healthcare System, Los Angeles, California, USA.
authors.forename: Sabine
authors.initials: S
authors.lastname: Oishi
authors.affiliation: VA HSR&D Center for the Study of Healthcare Innovation, Implementation &amp;Policy, VA Greater Los Angeles Healthcare System, Los Angeles, California, USA.
authors.forename: Andrew
authors.initials: A
authors.lastname: Lanto
authors.affiliation: VA HSR&D Center for the Study of Healthcare Innovation, Implementation &amp;Policy, VA Greater Los Angeles Healthcare System, Los Angeles, California, USA.
authors.forename: Martin
authors.initials: M
authors.lastname: Lee
authors.affiliation: VA HSR&D Center for the Study of Healthcare Innovation, Implementation &amp;Policy, VA Greater Los Angeles Healthcare System, Los Angeles, California, USA.|Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, California, USA.
authors.forename: Alison B
authors.identifier: 0000-0003-3998-7212
authors.initials: AB
authors.lastname: Hamilton
authors.affiliation: VA HSR&D Center for the Study of Healthcare Innovation, Implementation &amp;Policy, VA Greater Los Angeles Healthcare System, Los Angeles, California, USA.|Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, California, USA.
authors.forename: Elizabeth M
authors.identifier: 0000-0002-9385-0025
authors.initials: EM
authors.lastname: Yano
authors.affiliation: VA HSR&D Center for the Study of Healthcare Innovation, Implementation &amp;Policy, VA Greater Los Angeles Healthcare System, Los Angeles, California, USA.|Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California, USA.
authors.forename: Maren T
authors.identifier: 0000-0002-9105-1369
authors.initials: MT
authors.lastname: Scheuner
mesh_terms: D001291:Attitude of Health Personnel; D005820:Genetic Testing / Q000706:statistics & numerical data* / Q000639:trends; D006787:Hospitals, Veterans; D006801:Humans; D020407:Internet; D007857:Leadership; D018802:Patient-Centered Care; D012017:Referral and Consultation; D011795:Surveys and Questionnaires; D014481:United States; D014493:United States Department of Veterans Affairs / Q000458:organization & administration*; D014728:Veterans