Applying Population Management Best Practices to Preventive Genomic Medicine

项目总结/摘要 预防性基因组医学，特别是识别具有遗传性癌症风险的个体， 系统，有机会改善患者的寿命和生活质量。有能力揭露 通过基因组检测大大提高疾病风险，采取行动降低风险，并改善结果 而降低成本一直是基因组医学的长期承诺。对于遗传性癌症， 然而，在基因组检测后，对建议的风险管理的遵守率很低。此外，我们的飞行员 数据表明，在没有更清晰的概念之前，卫生系统不愿意扩大癌症基因组检测。 如何管理经过测试的患者。我们在这个应用程序中的目标是解决这个障碍，基因组 医学实施。具体来说，我们将展示采用人口管理的好处， 以遗传性癌症为例，基因组检测后的干预措施可以为卫生系统提供 example.我们将修订并严格评估两项人口管理干预措施（网络资源和 个性化外展服务），从而改善及时的患者外展服务和端到端跟踪，而不会增加负担 提供商网络资源是一种低接触的干预措施，将患者与现有的教育资源联系起来 (e.g., Facing Our Risk of Cancer Empowered网站）。个性化外展是一种高接触干预 将患者与专门的护理经理联系起来，讨论风险管理并提供护理提醒。 这两种干预措施都是高度可扩展的，反映了卫生系统拥有的人口管理计划。 用于支持癌症筛查，糖尿病管理和其他基于证据的护理数十年。我们将 在一项实用的混合1型随机试验中比较网络资源和个性化外展与常规护理 凯泽医疗机构（Kaiser Permanente）在两个卫生系统内的遗传性癌症登记处招募患者， 西北（KPNW）和丹佛健康（DH）。KPNW是一个纵向一体化的卫生系统，卫生署是一个 联邦合格的健康中心，提供两个高度独特的评估设置。我们的主要功效 结果是登记患者在两年内接受推荐癌症筛查的比例。 我们将收集二次实施结果，包括可接受性、适当性、可行性， 可持续性以及高接触和低接触干预方法的成本。通过为临床冠军提供 选择和执行人口管理干预措施， 在检测后质量和患者安全方面的差距，这一创新项目将推动预防性基因组 药

PROJECT SUMMARY/ABSTRACT Preventive genomic medicine, particularly identification of individuals with inherited cancer risk, provides health systems with the opportunity to improve longevity and quality of life for their patients. The ability to uncover substantially elevated risk of disease through genomic testing, act to reduce that risk, and improve outcomes while lowering costs has been the longstanding promise of genomic medicine. In the case of inherited cancer, however, adherence to recommended risk management following genomic testing is low. Further, our pilot data suggests that health systems are reluctant to expand cancer genomic testing without a clearer idea of how to manage tested patients over time. Our goal in this application is to address this roadblock to genomic medicine implementation. Specifically, we will demonstrate the benefits that adopting population management interventions following genomic testing can provide health systems, using hereditary cancer as a case example. We will revise and rigorously evaluate two population management interventions (web resources and personalized outreach) that improve timely patient outreach and end-to-end tracking without burdening providers. Web resources is a low-touch intervention that links patients with existing educational resources (e.g., the Facing Our Risk of Cancer Empowered website). Personalized outreach is a high-touch intervention that connects patients with a dedicated care manager to discuss risk management and provide care reminders. Both interventions are highly scalable and mirror population management programs that health systems have used to support cancer screening, diabetes management, and other evidence-based care for decades. We will compare web resources and personalized outreach to usual care in a pragmatic hybrid type-1 randomized trial that engages patients captured in hereditary cancer registries within two health systems, Kaiser Permanente Northwest (KPNW) and Denver Health (DH). KPNW is a vertically integrated health system and DH is a federally qualified health center, providing two highly unique evaluation settings. Our primary effectiveness outcome is the proportion of registry patients up to date with recommended cancer screening over two years. We will collect secondary implementation outcomes, including the acceptability, appropriateness, feasibility, sustainability, and costs of high- and low-touch intervention approaches. By providing clinical champions with essential data and tools to select and implement population management interventions that address critical gaps in post-testing quality and patient safety, this innovative project will advance preventive genomic medicine.