Qualitative Study of System-level Factors Related to Genomic Implementation

Overview

Journal Genet Med

Publisher Elsevier

Specialty Genetics

Date 2018 Nov 24

PMID 30467402

Citations 22

Authors

Alexis M Zebrowski

Darcy E Ellis

Frances K Barg

Nina R Sperber

Barbara A Bernhardt

Joshua C Denny

Paul R Dexter

Geoffrey S Ginsburg

Carol R Horowitz

Julie A Johnson

Mia A Levy

Lori A Orlando

Toni I Pollin

Todd C Skaar

Stephen E Kimmel

Affiliations

Soon will be listed here.

Abstract

Purpose: Research on genomic medicine integration has focused on applications at the individual level, with less attention paid to implementation within clinical settings. Therefore, we conducted a qualitative study using the Consolidated Framework for Implementation Research (CFIR) to identify system-level factors that played a role in implementation of genomic medicine within Implementing GeNomics In PracTicE (IGNITE) Network projects.

Methods: Up to four study personnel, including principal investigators and study coordinators from each of six IGNITE projects, were interviewed using a semistructured interview guide that asked interviewees to describe study site(s), progress at each site, and factors facilitating or impeding project implementation. Interviews were coded following CFIR inner-setting constructs.

Results: Key barriers included (1) limitations in integrating genomic data and clinical decision support tools into electronic health records, (2) physician reluctance toward genomic research participation and clinical implementation due to a limited evidence base, (3) inadequate reimbursement for genomic medicine, (4) communication among and between investigators and clinicians, and (5) lack of clinical and leadership engagement.

Conclusion: Implementation of genomic medicine is hindered by several system-level barriers to both research and practice. Addressing these barriers may serve as important facilitators for studying and implementing genomics in practice.

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