A logic model for precision medicine implementation informed by stakeholder views and implementation science

被引：22

作者：

Chanfreau-Coffinier, Catherine ^{[1
,2
]}

Peredo, Jane ^{[2
]}

Russell, Marcia M. ^{[2
,3
]}

Yano, Elizabeth M. ^{[2
,4
]}

Hamilton, Alison B. ^{[2
,5
]}

Lerner, Barbara ^{[6
]}

Provenzale, Dawn ^{[7
,8
]}

Knight, Sara J. ^{[9
,10
]}

Voils, Corrine I. ^{[11
,12
]}

Scheuner, Maren T. ^{[2
,13
]}

机构：

[1] VA Salt Lake City Healthcare Syst, VA Informat & Comp Infrastruct, Salt Lake City, UT USA

[2] VA Greater Los Angeles Healthcare Syst, VA HSR&D Ctr Study Healthcare Innovat Implementat, Los Angeles, CA 90073 USA

[3] Univ Calif Los Angeles, David Geffen Sch Med, Dept Surg, Los Angeles, CA 90095 USA

[4] Univ Calif Los Angeles, Dept Hlth Policy & Management, Fielding Sch Publ Hlth, Los Angeles, CA USA

[5] Univ Calif Los Angeles, David Geffen Sch Med, Dept Psychiat & Biobehav Sci, Los Angeles, CA 90095 USA

[6] VA Boston Healthcare Syst, VA Ctr Healthcare Org & Implementat Res, Boston, MA USA

[7] VA Cooperat Studies Program Epidemiol Ctr Durham, Durham, NC USA

[8] Duke Univ, Sch Med, Durham, NC USA

[9] Univ Utah, VA Salt Lake City Healthcare Syst, Salt Lake City, UT USA

[10] Univ Alabama Birmingham, Dept Med, Sch Med, Birmingham, AL USA

[11] William S Middleton Mem Vet Adm Med Ctr, Madison, WI USA

[12] Univ Wisconsin, Dept Surg, Sch Med & Publ Hlth, Madison, WI USA

[13] Univ Calif Los Angeles, David Geffen Sch Med, Dept Med, Los Angeles, CA 90095 USA

来源：

GENETICS IN MEDICINE | 2019年 / 21卷 / 05期

关键词：

precision medicine; logic model; implementation; GENOMIC MEDICINE; HEALTH-CARE;

D O I：

10.1038/s41436-018-0315-y

中图分类号：

Q3 [遗传学];

学科分类号：

071007 ; 090102 ;

摘要：

Purpose: Precision medicine promises to improve patient outcomes, but much is unknown about its adoption within health-care systems. A comprehensive implementation plan is needed to realize its benefits. Methods: We convened 80 stakeholders for agenda setting to inform precision medicine policy, delivery, and research. Conference proceedings were audio-recorded, transcribed, and thematically analyzed. We mapped themes representing opportunities, challenges, and implementation strategies to a logic model, and two implementation science frameworks provided context. Results: The logic model components included inputs: precision medicine infrastructure (clinical, research, and information technology), big data (from data sources to analytics), and resources (e.g., workforce and funding); activities: precision medicine research, practice, and education; outputs: precision medicine diagnosis; outcomes: personal utility, clinical utility, and health-care utilization; and impacts: precision medicine value, equity and access, and economic indicators. Precision medicine implementation challenges include evidence gaps demonstrating precision medicine utility, an unprepared workforce, the need to improve precision medicine access and reduce variation, and uncertain impacts on health-care utilization. Opportunities include integrated health-care systems, partnerships, and data analytics to support clinical decisions. Examples of implementation strategies to promote precision medicine are: changing record systems, data warehousing techniques, centralized technical assistance, and engaging consumers. Conclusion: We developed a theory-based, context-specific logic model that can be used by health-care organizations to facilitate precision medicine implementation.

引用

页码：1139 / 1154

页数：16

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