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Genetic testing outcomes in utilization management genetic counseling clinic compared to genetic testing ordered by non-genetics providers

Hoenig, Megan (2019) Genetic testing outcomes in utilization management genetic counseling clinic compared to genetic testing ordered by non-genetics providers. Master's Thesis, University of Pittsburgh. (Unpublished)

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Abstract

UPMC Children’s Hospital of Pittsburgh started the Genetic Testing Clinic (GTC) in January 2018. The GTC is a genetic counseling-only clinic that offers same-day and advance-scheduled appointments for referrals from non-genetic providers ordering a genetic test. This clinic is unique in that it incorporates utilization management (UM) for the requested genetic test while providing comprehensive genetic counseling. After one year and 459 patients, outcomes of the clinic, such as test order modifications, family history risk assessment and triage, and genetic test uptake were assessed. Upon IRB approval, retrospective chart review of the electronic medical record and internal databases were performed for 206 of the GTC patients to obtain detailed outcomes of the clinic. Additionally, chart review of genetic testing completed by non-genetics providers prior to the GTC’s inception in 2017 was performed for a comparison. Chart review identified 14.6% (30/206) of the GTC patients had unrelated family history risk factors, for which a referral to cancer genetics or cardiogenetics was provided and 7.3% (15/206) of GTC patients had their test modified based upon genetic counselor review. Finally, review of possible results, risks, benefits and limitations of genetic testing were discussed and documented routinely for GTC patients. In contrast, non-genetics providers often lacked documentation of the informed consent process. 77/150 (51%) of the non-genetics providers did not document any of the possible types of genetic testing results, 67/150 (45%) documented one type of possible genetic testing result; 112/150 (75%) did not document any risks, benefits or limitations; and 149/150 (99%) did not document the possibility of incidental findings. Genetic counseling is valuable for patients undergoing genetic testing; however, not every patient receives genetic counseling. This clinic represents a service delivery model that provides genetic counseling and UM for patients who may not have otherwise received it. This has public health significance as it improves access to genetic counseling services, ensures comprehensive pre- and post- test counseling, and has improved insurance authorization approval.


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Details

Item Type: University of Pittsburgh ETD
Status: Unpublished
Creators/Authors:
CreatorsEmailPitt UsernameORCID
Hoenig, Meganmeh203@pitt.edumeh2030000-0001-7770-9841
ETD Committee:
TitleMemberEmail AddressPitt UsernameORCID
Committee ChairVento, JodieJodie.Vento@chp.edu
Committee MemberDurst, Andreaadurst@pitt.edu0000-0002-4338-5823
Committee MemberMunro, Christinechristine.munro2@chp.edu
Committee MemberYouk, Adaayouk@pitt.edu0000-0001-6912-9759
Date: 25 May 2019
Defense Date: 22 May 2019
Approval Date: 19 July 2019
Submission Date: 3 June 2019
Access Restriction: No restriction; Release the ETD for access worldwide immediately.
Number of Pages: 154
Institution: University of Pittsburgh
Schools and Programs: Graduate School of Public Health > Genetic Counseling
Graduate School of Public Health > Public Health Genetics
Degree: MS - Master of Science
Thesis Type: Master's Thesis
Refereed: Yes
Uncontrolled Keywords: Genetic testing Genetic counseling Utilization management Non-genetics providers
Date Deposited: 19 Jul 2019 21:47
Last Modified: 19 Jul 2019 21:47
URI: http://d-scholarship.pitt.edu/id/eprint/36884

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