Promoting appropriate genetic testing: the impact of a combined test review and consultative service

• Published in: Genetics in medicine Vol. 19; no. 9; pp. 1049 - 1054
• Main Authors: Suarez, Carlos J., Yu, Linbo, Downs, Natalie, Costa, Helio A., Stevenson, David A.
• Format: Journal Article
• Language: English
• Published: New York Nature Publishing Group US 01-09-2017; Elsevier Limited
• Subjects: 631/208/2489; 692/700/139/1512; 692/700/228/2050; Biomedical and Life Sciences; Biomedicine; Genetic testing; Genetic Testing - methods; Genetic Testing - standards; Health Promotion; Health Services Misuse; Human Genetics; Humans; Laboratory Medicine; Management by crisis; original-research-article; Referral and Consultation - standards; medical errors; reduction of misorders; utilization management; types of misorders; genetic testing
• ISSN: 1098-3600; 1530-0366
• DOI: 10.1038/gim.2016.219

Purpose:
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.
Methods:
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.
Results:
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.
Conclusion:
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