title: Promoting appropriate genetic testing: the impact of a combined test review and consultative service.
abstract: Genetic test misorders can adversely affect patient care. However, little is known about the types of misorders and the overall impact of a utilization management (UM) program on curbing misorders. This study aimed to identify different types of misorders and analyze the impact of a combined test review and consultative service on reducing misorders over time.
  
  
  
  Selected genetic tests were systematically reviewed between January and December 2015 at Stanford Health Care. Misorders were categorized into five types: clerical errors, redundant testing, better alternatives, controversial, and uncategorized. Moreover, consultations were offered to help clinicians with test selection.
  
  
  
  Of the 629 molecular test orders reviewed, 13% were classified as misorders, and 7% were modified or canceled. Controversial misorders constitute the most common type (42%); however, unlike the other misorder types, they were negligibly affected by test review. Simultaneously, 71 consults were received. With the introduction of the UM program, genetic test misorders went from 22% at baseline to 3% at the end of the year.
  
  
  
  Our results show that the combined approach of test review and consultative service effectively reduced misorders over time and suggest that a UM program focused on eliminating misorders can positively influence health-care providers' behaviors.Genet Med advance online publication 26 January 2017.
authors.affiliation: Department of Pathology, Stanford University, Stanford, California, USA.
authors.forename: Carlos J
authors.initials: CJ
authors.lastname: Suarez
authors.affiliation: Stanford Health Care, Stanford, California, USA.
authors.forename: Linbo
authors.identifier: 0000-0002-3675-9022
authors.initials: L
authors.lastname: Yu
authors.affiliation: Stanford Health Care, Stanford, California, USA.
authors.forename: Natalie
authors.identifier: 0000-0001-6445-8588
authors.initials: N
authors.lastname: Downs
authors.affiliation: Department of Genetics, Stanford University, Stanford, California, USA.
authors.forename: Helio A
authors.identifier: 0000-0002-1848-3472
authors.initials: HA
authors.lastname: Costa
authors.affiliation: Department of Pediatrics, Division of Medical Genetics, Stanford University, Stanford, California, USA.
authors.forename: David A
authors.initials: DA
authors.lastname: Stevenson
mesh_terms: D005820:Genetic Testing / Q000379:methods / Q000592:standards; D006293:Health Promotion; D006300:Health Services Misuse; D006801:Humans; D012017:Referral and Consultation / Q000592:standards