Qualitative study of system-level factors related to genomic implementation

Alexis M. Zebrowski, Darcy E. Ellis, Frances K. Barg, Nina R. Sperber, Barbara A. Bernhardt, Joshua C. Denny, Paul Dexter, Geoffrey S. Ginsburg, Carol R. Horowitz, Julie A. Johnson, Mia A. Levy, Lori A. Orlando, Toni I. Pollin, Todd Skaar, Stephen E. Kimmel

Research output: Contribution to journalArticle

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.

Original languageEnglish (US)
JournalGenetics in Medicine
DOIs
StateAccepted/In press - Jan 1 2018

Fingerprint

Genomics
Medicine
Research
Clinical Decision Support Systems
Research Personnel
Interviews
Electronic Health Records
Communication
Physicians

Keywords

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

ASJC Scopus subject areas

  • Genetics(clinical)

Cite this

Zebrowski, A. M., Ellis, D. E., Barg, F. K., Sperber, N. R., Bernhardt, B. A., Denny, J. C., ... Kimmel, S. E. (Accepted/In press). Qualitative study of system-level factors related to genomic implementation. Genetics in Medicine. https://doi.org/10.1038/s41436-018-0378-9

Qualitative study of system-level factors related to genomic implementation. / Zebrowski, Alexis M.; Ellis, Darcy E.; Barg, Frances K.; Sperber, Nina R.; Bernhardt, Barbara A.; Denny, Joshua C.; Dexter, Paul; Ginsburg, Geoffrey S.; Horowitz, Carol R.; Johnson, Julie A.; Levy, Mia A.; Orlando, Lori A.; Pollin, Toni I.; Skaar, Todd; Kimmel, Stephen E.

In: Genetics in Medicine, 01.01.2018.

Research output: Contribution to journalArticle

Zebrowski, AM, Ellis, DE, Barg, FK, Sperber, NR, Bernhardt, BA, Denny, JC, Dexter, P, Ginsburg, GS, Horowitz, CR, Johnson, JA, Levy, MA, Orlando, LA, Pollin, TI, Skaar, T & Kimmel, SE 2018, 'Qualitative study of system-level factors related to genomic implementation', Genetics in Medicine. https://doi.org/10.1038/s41436-018-0378-9
Zebrowski AM, Ellis DE, Barg FK, Sperber NR, Bernhardt BA, Denny JC et al. Qualitative study of system-level factors related to genomic implementation. Genetics in Medicine. 2018 Jan 1. https://doi.org/10.1038/s41436-018-0378-9
Zebrowski, Alexis M. ; Ellis, Darcy E. ; Barg, Frances K. ; Sperber, Nina R. ; Bernhardt, Barbara A. ; Denny, Joshua C. ; Dexter, Paul ; Ginsburg, Geoffrey S. ; Horowitz, Carol R. ; Johnson, Julie A. ; Levy, Mia A. ; Orlando, Lori A. ; Pollin, Toni I. ; Skaar, Todd ; Kimmel, Stephen E. / Qualitative study of system-level factors related to genomic implementation. In: Genetics in Medicine. 2018.
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