Strategies to Integrate Genomic Medicine into Clinical Care: Evidence from the IGNITE Network.

Nina R Sperber,Tejinder Rakhra-Burris,Amanda R Elsey,Geoffrey S Ginsburg,Todd Skaar,Kenneth D Levy,Megan C Roberts,Lori A Orlando,Carol R Horowitz,Toni I Pollin,Michelle A Ramos,Paul Dexter,Josh F Peterson,Olivia M Dong,Julie A Johnson,Henry Ong

doi:10.3390/jpm11070647

Abstract

The complexity of genomic medicine can be streamlined by implementing some form of clinical decision support (CDS) to guide clinicians in how to use and interpret personalized data; however, it is not yet clear which strategies are best suited for this purpose. In this study, we used implementation science to identify common strategies for applying provider-based CDS interventions across six genomic medicine clinical research projects funded by an NIH consortium. Each project’s strategies were elicited via a structured survey derived from a typology of implementation strategies, the Expert Recommendations for Implementing Change (ERIC), and follow-up interviews guided by both implementation strategy reporting criteria and a planning framework, RE-AIM, to obtain more detail about implementation strategies and desired outcomes. We found that, on average, the three pharmacogenomics implementation projects used more strategies than the disease-focused projects. Overall, projects had four implementation strategies in common; however, operationalization of each differed in accordance with each study’s implementation outcomes. These four common strategies may be important for precision medicine program implementation, and pharmacogenomics may require more integration into clinical care. Understanding how and why these strategies were successfully employed could be useful for others implementing genomic or precision medicine programs in different contexts.

Highlights

Precision medicine represents a new, emerging paradigm for healthcare by tailoring treatments to individuals on the basis of characteristics that include biological, behavioral, and demographic data
The IGNITE network consisted of six diverse genomic medicine demonstration projects led by academic medical centers allied with community healthcare systems that varied in their goals and approach
We present the two strategies having to do with the training and educating stakeholders strategy cluster together in one table (Table 3), because, they are discrete strategies according to the Expert Recommendations for Implementing Change (ERIC) typology, results indicated that they went hand-in-hand for these genomic medicine implementations

Summary

Introduction

Precision medicine represents a new, emerging paradigm for healthcare by tailoring treatments to individuals on the basis of characteristics that include biological, behavioral, and demographic data. Complexity, and novelty of information needed to practice precision medicine, implementation must include tools to help clinicians and patients interpret and act on the information [1]. These tools include clinical decision supports (CDS), i.e.,. To provide just-in-time prompts for clinicians or information for patients [3]. They have proven efficacious for translating genomic medicine into clinical care [4,5]

Methods

Discussion

Conclusion