Title: Measuring the quality of genomic health services in the VA: A pilot PI: Mark Meterko, PhD Background: The rate at which clinically relevant genomic tests are being developed is accelerating, particularly for chronic adult-onset conditions such as heart disease, mental illness and cancer. These test results can affect medical management and long-term health. Consistent with this trend, the VA is increasing its delivery of genomic services including testing for diagnostic and predictive purposes. Research to compare the clinical effectiveness of genomic service delivery models is critical to ensure that VA develops, implements and disseminates genomic services that are both effective and veteran-centered. Objectives(s): The overall objective of this pilot study is to adapt and augment measures of genomics care process and patient outcomes to address the unique characteristics and needs of veteran patients receiving genomic medical services. Specifically, the proposed study has four aims: (1) Identify in detail the key process steps and patient outcomes of VA genomic services, (2) Develop two data collection instruments to measure those (a) process characteristics and (b) outcome dimensions, (3) Rigorously test those instruments for comprehension (content) and ease of administration (format), and (4) Revise the instruments based on that testing for use in a future comparative clinical effectiveness study of genomics medical service model. Research Design & Methodology: The proposed pilot study will use classical scale development methodology including a review of the literature, in-depth provider interviews, patient focus groups, as well as cognitive interviewing to develop process and patient outcome measurement instruments. Each study aim will be the focus of its own phase of the pilot and will employ specific, appropriate methodologies following the overall model outlined by Dillman. [31]
The use of genomic health services is expanding across the VA. In 2006 the VA took the initial steps to launch the Genomic Medicine Program and subsequently established the HSR&D Genomics Health Services portfolio with the purpose of supporting research for evidence-based genomic medical services. Studies are underway to identify the various delivery models being used, but at this point the differential effectiveness of those models is unknown. A major roadblock to measuring effectiveness is the lack of comprehensive measurement instruments that address the unique characteristics of the VA healthcare system and its patients' needs. The development of instruments to measure process and patient outcomes is a necessary first step to conducting studies comparing the quality of care provided by the different models of genomics medical services used within VA and thereby identify best practices.
