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Genet Med. 2018 Nov 23. doi: 10.1038/s41436-018-0378-9. [Epub ahead of print]

Qualitative study of system-level factors related to genomic implementation.

Author information

1
Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia, PA, USA.
2
Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA.
3
Department of Family Medicine and Community Health, University of Pennsylvania, Philadelphia, PA, USA.
4
Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center, Durham, NC, USA.
5
Division of Translational Medicine and Human Genetics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
6
Departments of Biomedical Informatics and Medicine, Vanderbilt University School of Medicine, Nashville, TN, USA.
7
Division of General Internal Medicine, Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN, USA.
8
Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA.
9
Duke Center for Applied Genomics and Precision Medicine, Duke University Medical Center, Durham, NC, USA.
10
Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
11
Department of Pharmacotherapy and Translational Research and Center for Pharmacogenomics, University of Florida College of Pharmacy, Gainesville, FL, USA.
12
Departments of Biomedical Informatics and Medicine, Division of Hematology and Oncology, Vanderbilt University School of Medicine, Nashville, TN, USA.
13
Division of General Internal Medicine, Department of Medicine, Duke University Medical Center, Durham, NC, USA.
14
University of Maryland School of Medicine, Baltimore, MD, USA.
15
Division of Clinical Pharmacology, Indiana University School of Medicine, Indianapolis, IN, USA.
16
Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia, PA, USA. stevek@pennmedicine.upenn.edu.
17
Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA. stevek@pennmedicine.upenn.edu.
18
Department of Medicine, Pearlman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA. stevek@pennmedicine.upenn.edu.

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.

KEYWORDS:

clinical engagement; electronic health record; genomics; implementation; qualitative

PMID:
30467402
DOI:
10.1038/s41436-018-0378-9

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