Elsevier

Genetics in Medicine

Volume 19, Issue 9, September 2017, Pages 1049-1054
Genetics in Medicine

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

https://doi.org/10.1038/gim.2016.219Get rights and content
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Abstract

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

Keywords

genetic testing
medical errors
reduction of misorders
types of misorders
utilization management

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