Population Management for Hereditary Cancer Prevention: Implementation, Effectiveness, and Acceptability within a Learning Health System.

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PROJECT SUMMARY/ABSTRACT The objective of this Mentored Clinical Scientist Research Career Development Award (K08) is to provide Dr. Sarah Knerr with training, mentoring, research experience, and protected time to transition her career into genomic medicine and develop into an independent academic researcher. Dr. Knerr has an MPH in public health genetics and a PhD in health services research. She is currently Acting Assistant Professor, University of Washington Department of Health Services. Her career goals include: (1) conducting health services research that increases the generalizability and relevance of the genomic medicine literature, (2) becoming an expert in evaluating genomic health care delivery interventions, (3) using implementation science tools to accelerate genomic translation, and (4) obtaining funding to support an interdisciplinary research career. The didactic and experiential training activities outlined in this three-year K08 award will thus provide her with essential skills in leading pragmatic research within learning health care systems, evaluating health care programs using quasi-experimental designs, applying implementation science theories and methods to genomic health care delivery, and developing competitive grant applications. The complementary research project leverages the launch of a hereditary breast and ovarian cancer (HBOC) population management program within the Kaiser Permanente Washington (KPWA) health system. Building on Dr. Knerr’s prior work studying BRCA test utilization trends within KPWA, and through the following specific aims, the proposed study will generate novel data about the implementation, effectiveness, and acceptability of population-focused health care delivery programs in hereditary cancer genomics. Aim 1 will identify program implementation barriers and facilitators using ethnographic observation, document review, and key informant interviews. Aim 2 will use interviews to investigate patient experiences, satisfaction, and informational needs in the context of a clinical HBOC population management program. Aim 3 will determine program effects on genetic counseling referral and genetic services utilization within the KPWA population using routinely collected administrative data and an interrupted time series study design. This work supports current national priorities in genomic medicine and hereditary cancer prevention and control. Study findings can inform the implementation of genomic screening programs across disease areas, developing the clinical infrastructure needed to translate genomic advances into population-level health improvements. An outstanding team of mentors and advisors with expertise in genomic medicine, cancer prevention and control, implementation science, health program evaluation, and interrupted time series analysis will support Dr. Knerr in her training and research goals. The K08 activities lay the foundation for future R-level applications focused on refining and testing implementation strategies and supports for HBOC population management programs as well as follow-up studies of long-term program outcomes (e.g., risk-management uptake, quality of life, costs) within the KPWA system.